Abstract 15811: Translesional Pressure Gradients to Predict the Blood Pressure Response after Renal Artery Stenting in Patients with Renovascular Hypertension
Background: In previous randomized trials, renal artery angioplasty has shown little clinical benefit in improving blood pressure in patients with renovascular hypertension. However, patients were mainly selected on the basis of angiographic parameters of the renal artery stenosis (RAS). Aim of the present study was to evaluate whether translesional pressure gradients could identify the patients with RAS who might benefit from angioplasty.
Methods: A total of 53 consecutive hypertensive patients with unilateral RAS scheduled for renal artery intervention were recruited. Transstenotic pressure gradients were measured at baseline and during maximal hyperemia, prior to renal artery stenting. Twenty-four hours ambulatory blood pressure measurements were performed in all patients prior to and three months after the intervention.
Results: Average reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at follow-up were −20±30 mm Hg and −2±12 mm Hg, respectively. At multivariate analysis, dopamine-induced mean gradient was the only independent predictor of the variations of both SBP (regression coefficient=−3.80, standard error=1.41; p=0.009) and DBP (regression coefficient=−2.98, standard error=1.09; p=0.006). Patients who showed a decline in SBP from the baseline value greater than 20 mm Hg were considered as “responders”. The optimal cut-off for identification of “responders” was a dopamine-induced mean gradient ≥ 20 mm Hg (AUC: 0.77, 95% confidence interval 0.64–0.90; p=0.001).
Conclusions: A dopamine-induced mean pressure gradient of ≥ 20 mm Hg is highly predictive of arterial hypertension improvement after renal stenting and, therefore, this measurement is useful for appropriate selection of patients with arterial hypertension.
- © 2010 by American Heart Association, Inc.