Abstract 14283: Time Dependant Changes in Systolic Blood Pressure after Renal Artery Stenting: Role of Stenosis Severity
Introduction: The timing of changes in blood pressure (BP) after stenting in patients with renal artery stenosis and drug resistant hypertension are not well defined. BP before, 1-month and 6-months after renal artery stenting were evaluated in 100 patients. Hypothesis: Stenosis severity influences changes in systolic BP after stent revascularization.
Methods: In a prospective trial patients were randomly assigned to an embolic protection device or double-blind use of a platelet glycoprotein IIb/IIIa inhibitor. Angiograms were analyzed at an independent core lab. BP measurements were performed by protocol in triplicate after 5 minutes seated in a quiet room using the same arm for all visits.
Results: BP decreased from baseline to 1- and 6-months (159±30, 147±26, and 142±20 mmHg, respectively, P=0.0001). At baseline 76% were above goal for systolic BP. The number of anti-hypertensive (AHTN) medications at baseline was 3±1. The change in systolic BP between baseline and 1-month was highly correlated with baseline BP (cc -0.59, P<0.0001) and pre-procedure percent stenosis (cc -0.28, P<0.01). There was a significant interaction between stenosis severity, defined as ≥70% or <70%, and time on change in systolic BP from baseline to 1-month and 1-month to 6-months (P=0.023, Figure 1). Patients with severe stenoses had a marked early decline in BP (161±28 vs 141±21, P=0.0001) whereas patients with less severe stenoses had a late (1-6 months) decline (156±32 vs 141±18, P=0.0007). The number of AHTN medications, class, or dose was not related to systolic BP changes (P=0.60, P=0.61 and P=0.74).
Conclusion: The time dependent changes in BP after stenting are strongly influenced by stenosis severity, with a marked early decrease seen in patients with stenoses ≥70%, and are independent of AHTN medications. Figure 1. Interaction plot of systolic blood pressure measured over time and pre-procedure stenosis severity.
- © 2012 by American Heart Association, Inc.