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ATHEROSCLEROSIS / CLINICAL RESEARCH
Preoperative clinical and renal ultrasonography variables associated with systolic and diastolic blood pressure reduction after renal artery stenting
1
Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
2
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Collegium Medicum, The John Paul II Hospital, Krakow, Poland
3
Department of Interventional Cardiology, The John Paul II Hospital, Krakow, Poland
4
Department of Statistics, Cracow University of Economics, Krakow, Poland
5
Department of Interventional Cardiology, Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, The John Paul II Hospital, Krakow, Poland
Submission date: 2020-06-26
Final revision date: 2020-08-13
Acceptance date: 2020-08-30
Online publication date: 2021-04-30
Corresponding author
Anna Kabłak-Ziembicka
Department of Interventional Cardiology Jagiellonian University Medical College Prądnicka 80 31-202 Krakow, Poland
Department of Interventional Cardiology Jagiellonian University Medical College Prądnicka 80 31-202 Krakow, Poland
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The response to stent-assisted angioplasty (PTA) in hypertensive patients with atherosclerotic renal artery stenosis (ARAS) is unpredictable. Therefore, the present study aimed to identify preoperative clinical and renal ultrasonography variables associated with systolic (SBP) and diastolic blood pressure (DBP) reduction.
Material and methods:
Preoperative clinical assessment and renal ultrasonography were performed in 202 patients who underwent PTA for ARAS (2003–2018). Patients were categorized as responders if a decrease of SBP of at least 20 mm Hg or DBP of 5 mm Hg was achieved. Logistic regression models were used to evaluate the associations of clinical and ultrasonographic variables with treatment response, and their relative contributions were assessed.
Results:
Logistic regression analysis showed that preoperative SBP > 145 mm Hg (OR = 20.0 [95% CI: 8.67–46.2], p < 0.001), (2) baseline DBP > 82 mm Hg (OR = 3.46 [95% CI: 1.61–7.42], p = 0.001), (3) prior myocardial infarction (OR = 3.14 [95% CI: 1.09–9.0], p = 0.033), and (4) renal-aortic ratio > 5.1 (OR = 2.67 [95% CI: 1.20–6.0], p = 0.016) predicted the SBP response, with respective relative contributions of 69.8%, 12.1%, 10.9% and 7.2%. The DBP response was associated with (1) baseline SBP > 145 mm Hg (OR = 3.79 [95% CI: 1.87–7.70], p < 0.001), (2) baseline DBP > 82 mm Hg (OR = 6.09 [95% CI: 2.88–12.9], p < 0.001), (3) ARAS progression (OR = 0.32 [95% CI: 0.09–1.07], p = 0.062), (4) contralateral kidney length > 106 mm (OR = 0.43 [95% CI: 0.22–0.86], p = 0.017), and (5) bilateral PTA (OR = 2.39 [95% CI: 1.08–5.27], p = 0.03), with respective contributions of 21.8%, 35.0%, 18.2%, 13.3% and 11.8%.
Conclusions:
This study identified clinical and ultrasonographic characteristics of patients who are likely to respond to PTA for ARAS. The RAR and contralateral kidney size may improve the identification of patients likely to respond to PTA.
The response to stent-assisted angioplasty (PTA) in hypertensive patients with atherosclerotic renal artery stenosis (ARAS) is unpredictable. Therefore, the present study aimed to identify preoperative clinical and renal ultrasonography variables associated with systolic (SBP) and diastolic blood pressure (DBP) reduction.
Material and methods:
Preoperative clinical assessment and renal ultrasonography were performed in 202 patients who underwent PTA for ARAS (2003–2018). Patients were categorized as responders if a decrease of SBP of at least 20 mm Hg or DBP of 5 mm Hg was achieved. Logistic regression models were used to evaluate the associations of clinical and ultrasonographic variables with treatment response, and their relative contributions were assessed.
Results:
Logistic regression analysis showed that preoperative SBP > 145 mm Hg (OR = 20.0 [95% CI: 8.67–46.2], p < 0.001), (2) baseline DBP > 82 mm Hg (OR = 3.46 [95% CI: 1.61–7.42], p = 0.001), (3) prior myocardial infarction (OR = 3.14 [95% CI: 1.09–9.0], p = 0.033), and (4) renal-aortic ratio > 5.1 (OR = 2.67 [95% CI: 1.20–6.0], p = 0.016) predicted the SBP response, with respective relative contributions of 69.8%, 12.1%, 10.9% and 7.2%. The DBP response was associated with (1) baseline SBP > 145 mm Hg (OR = 3.79 [95% CI: 1.87–7.70], p < 0.001), (2) baseline DBP > 82 mm Hg (OR = 6.09 [95% CI: 2.88–12.9], p < 0.001), (3) ARAS progression (OR = 0.32 [95% CI: 0.09–1.07], p = 0.062), (4) contralateral kidney length > 106 mm (OR = 0.43 [95% CI: 0.22–0.86], p = 0.017), and (5) bilateral PTA (OR = 2.39 [95% CI: 1.08–5.27], p = 0.03), with respective contributions of 21.8%, 35.0%, 18.2%, 13.3% and 11.8%.
Conclusions:
This study identified clinical and ultrasonographic characteristics of patients who are likely to respond to PTA for ARAS. The RAR and contralateral kidney size may improve the identification of patients likely to respond to PTA.
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| eISSN: | 1896-9151 |
| ISSN: | 1734-1922 |
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