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Previous Volume 342:1007-1014 April 6, 2000 Number 14 Next

	Full Text PDF Editorial by Ritz, E. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood.

Methods We randomly assigned 106 patients with hypertension who had atherosclerotic renal-artery stenosis (defined as a decrease in luminal diameter of 50 percent or more) and a serum creatinine concentration of 2.3 mg per deciliter (200 µmol per liter) or less to undergo percutaneous transluminal renal angioplasty or to receive drug therapy. To be included, patients also had to have a diastolic blood pressure of 95 mm Hg or higher despite treatment with two antihypertensive drugs or an increase of at least 0.2 mg per deciliter (20 µmol per liter) in the serum creatinine concentration during treatment with an angiotensin-converting–enzyme inhibitor. Blood pressure, doses of antihypertensive drugs, and renal function were assessed at 3 and 12 months, and patency of the renal artery was assessed at 12 months.

Results At base line, the mean (±SD) systolic and diastolic blood pressures were 179±25 and 104±10 mm Hg, respectively, in the angioplasty group and 180±23 and 103±8 mm Hg, respectively, in the drug-therapy group. At three months, the blood pressures were similar in the two groups (169±28 and 99±12 mm Hg, respectively, in the 56 patients in the angioplasty group and 176±31 and 101±14 mm Hg, respectively, in the 50 patients in the drug-therapy group; P=0.25 for the comparison of systolic pressure and P=0.36 for the comparison of diastolic pressure between the two groups); at the time, patients in the angioplasty group were taking 2.1±1.3 defined daily doses of medication and those in the drug-therapy group were taking 3.2±1.5 daily doses (P<0.001). In the drug-therapy group, 22 patients underwent balloon angioplasty after three months because of persistent hypertension despite treatment with three or more drugs or because of a deterioration in renal function. According to intention-to-treat analysis, at 12 months, there were no significant differences between the angioplasty and drug-therapy groups in systolic and diastolic blood pressures, daily drug doses, or renal function.

Conclusions In the treatment of patients with hypertension and renal-artery stenosis, angioplasty has little advantage over antihypertensive-drug therapy.

Source Information

From the Departments of Internal Medicine (B.C.J., F.H.M.D., J.D., A.J.M.V., M.A.D.H.S.) and Radiology (H.P.), Erasmus University Hospital, Rotterdam; the Center for Clinical Decision Sciences, Department of Public Health, Erasmus University, Rotterdam (P.K.); the Department of Internal Medicine, University Hospital, Nijmegen (C.T.P.); the Department of Internal Medicine, Ikazia Hospital, Rotterdam (A.D.); the Department of Internal Medicine, Twenteborg Hospital, Almelo (A.J.J.W.); and the Department of Internal Medicine, Eemland Hospital, Amersfoort (A.K.M.B.) — all in the Netherlands.

Address reprint requests to Dr. van Jaarsveld at Stichting Dianet, Brennerbaan 130, 3524 BN Utrecht, the Netherlands, or at b.v.jaarsveld{at}utr.dianet.nl.

Full Text of this Article

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The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis
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Extract | Full Text  
N Engl J Med 2000; 343:438-439, Aug 10, 2000. Correspondence

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