Effect of Renal Artery Stenting on Blood Pressure, Glomerular Filtration Rate and Left Ventricular Mass in Hypertensive Patients with Severe Atherosclerotic Renal Artery Stenosis

Authors

1 Professor of Cardiology, Mashhad University of Medical sciences, Mashhad, Iran

2 MD, Ghaem Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 MD, Pediatric Resident, Mashhad University of Medical Sciences, Mashhad, Iran

4 MD, Department of Nephrology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

5 PhD, Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Abstract Background: Many small trials showed a significant improvement in blood pressure following renal artery stenting in patients with severe atherosclerotic renal artery stenosis, but data on renal function improvement is more conflicting. Recently, few trials have been conducted to evaluate the effect of this procedure on Left Ventricular Mass (LVM) and Left Ventricular Mass Index (LVMI). Objectives: The aim of this study is to determine the effect of renal artery stenting on Blood Pressure, estimated Glomerular Filtration Rate (eGFR), Left Ventricular Mass (LVM), and Left Ventricular Mass Index (LVMI) in patients with severe atherosclerotic renal artery stenosis. Methods: This is a prospective interventional study performed on forty patients with ischemic heart disease and medication resistant hypertension, who had severe ( 70%) atherosclerotic renal artery stenosis and underwent renal artery stenting. Blood pressure, LVM, LVMI and eFGR before renal artery stenting and after six months were assessed in these patients. Results: There were significant reduction in systolic blood pressure (from 175.5017.28mmHgto 137.3013.21mmHg)(P < 0.001), and diastolic blood pressure (from 103.45  8.91 mmHg to 84.30  7.33 mmHg) (P < 0.001). Also, there were significant decrease in LVM (from 307.73  108.13 g to 259.34  92.17 g) (P = 0.004) and LVMI (from 174.70  58.26 to 148.01  49.77) (P = 0.004). LVM reduction was independent of SBP and DBP reduction (P = 0.376 and P = 0.196, respectively). Conclusions: Renal artery stenting reduces Blood pressure and leads to regression of LVM independent of blood pressure reduction. Regardless of baseline eGFR, our study failed to find a significant increase in glomerular filtration rate.

Keywords

References

  1. 1.van Jaarsveld BC, Krijnen P, Pieterman H, Derkx FH, Deinum J, Postma CT, et al. The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group.N Engl J Med. 2000;342(14):1007– 14. doi: 10.1056/NEJM200004063421403. [PubMed: 10749962].

    1. Dworkin LD, Cooper CJ. Clinical practice. Renal-artery stenosis. N Engl J Med. 2009;361(20):1972–8. doi: 10.1056/NEJMcp0809200. [PubMed: 19907044].
    2. Kalra P. The impact of renal artery revascularisation in atherosclerotic renovascular disease: the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial. SCAI-ACC i2 Summit/American College of Cardiology Annual Scientific Session; 2008.
    3. Kobo O, Hammoud M, Makhoul N, Omary H, Rosenschein U. Screening, diagnosis, and treatment of renal artery stenosis by percutaneous transluminal renal angioplasty with stenting. Isr Med Assoc J. 2010;12(3):140–3. [PubMed: 20684176].
    4. Ruchin PE, Baron DW, Wilson SH, Boland J, Muller DW, Roy PR. Longterm follow-up of renal artery stenting in an Australian population. Heart Lung Circ. 2007;16(2):79–84. doi: 10.1016/j.hlc.2006.12.008. [PubMed: 17317314].
    5. Dervisoglu E, Ciftci E, Selek A, Sarisoy HT, Kalender B, Yilmaz A. Percutaneous renal artery stenting reduces arterial blood pressure, but what about renal function? A single-center experience. Anadolu Kardiyol Derg. 2010;10(1):61–5. [PubMed: 20150008].
    6. Morice MC, Marco J, Laborde JC, Fourrier JL, Raynaud A, Labrunie P, et al. [Results of the French register of renal stenting: the Esternal study]. Arch Mal Coeur Vaiss. 2007;100(10):827–32. [PubMed: 18033012].
    7. ShabestariM, Sharifipour F, DadollahiM, HaghmoradiM.Ms410 Short Term (3 Months) Evaluation of Renal Artery Stenting and Angioplasty in Patients with Hypertension and Renal Artery Stenosis. Atherosclerosis Supplements. 2010;11(2):193. doi: 10.1016/s1567-5688(10)70911-9.
    8. Ramos F, Kotliar C, Alvarez D, Baglivo H, Rafaelle P, Londero H, et al. Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis. Kidney Int. 2003;63(1):276–82. doi: 10.1046/j.1523- 1755.2003.00734.x. [PubMed: 12472793].
    9. Zeller T, Rastan A, Schwarzwalder U, Muller C, Frank U, Burgelin K, et al. Regression of left ventricular hypertrophy following stenting of renal artery stenosis.J Endovasc Ther. 2007;14(2):189–97. doi: 10.1583/1545- 1550(2007)14[189:ROLVHF]2.0.CO;2. [PubMed: 17488176].
    10. Rzeznik D, Przewlocki T, Kablak-Ziembicka A, Kozanecki A, Roslawiecka A, Lach J, et al. Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the one-year outcome. J Vasc Surg. 2011;53(3):692–7. doi: 10.1016/j.jvs.2010.09.054. [PubMed: 21129903]. Razavi Int J Med. 2017; 5(1):e43288. 5 Dehghani Dashtabi M et al.
    11. Marcantoni C, Zanoli L, Rastelli S, Tripepi G, Matalone M, Di Landro D, et al. Stenting of renal artery stenosis in coronary artery disease (RASCAD) study: a prospective, randomized trial. J Nephrol. 2009;22(1):13– 6. [PubMed: 19229814].
    12. Symonides B, Chodakowska J, Januszewicz A, Lapinski M, Januszewicz M, Rowinski O, et al. Effects of the correction of renal artery stenosis on blood pressure, renal function and left ventricular morphology. Blood Press. 1999;8(3):141–50. [PubMed: 10595691].
    13. Froissart M, Rossert J, Jacquot C, Paillard M, Houillier P. Predictive performance of the modification of diet in renal disease and CockcroftGault equations for estimating renal function. J Am Soc Nephrol. 2005;16(3):763–73. doi: 10.1681/ASN.2004070549. [PubMed: 15659562].
    14. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55(4):613–8. [PubMed: 138494].
    15. Briars GL, Bailey BJ. Surface area estimation: pocket calculator v nomogram. Arch Dis Child. 1994;70(3):246–7. [PubMed: 8135573].
    16. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29(19):2388–442. doi: 10.1093/eurheartj/ehn309. [PubMed: 18799522].
    17. Zeller T, Frank U, Muller C, Burgelin K, Sinn L, Bestehorn HP, et al. Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis. Circulation. 2003;108(18):2244–9. doi: 10.1161/01.CIR.0000095786.44712.2A. [PubMed: 14557357].
    18. Duprez DA, Bauwens FR, De Buyzere ML, De Backer TL, Kaufman JM, Van Hoecke J, et al. Influence of arterial blood pressure and aldosterone on left ventricular hypertrophy in moderate essential hypertension. Am J Cardiol. 1993;71(3):17A–20A. [PubMed: 8421999].
Razavi International Journal of Medicine
Volume 5, Issue 1
January 2017

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