LACK OF EFFECT OF PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY ON NOCTURNAL HYPOTENSION IN RENOVASCULAR HYPERTENSIVE PATIENTS

Objective To investigate whether nocturnal blood pressure fall is blun ted in renovascular hypertension and can therefore be used as a diagno stic criterion for this condition. Methods In 14 renovascular hyperten sive patients (age 43.8 +/- 2.1 years, mean +/- SEM, clinic blood pres sure 173.6 +/- 3.7 mmHg systolic and 109.0 +/- 2.0 mmHg diastolic) and in 14 age- and blood pressure-matched essential hypertensive controls 24 h ambulatory blood pressure was measured after washout from drug t reatment, during angiotensin converting enzyme inhibitor treatment and , in renovascular hypertension, also after percutaneous transluminal r enal angioplasty. Results The 24 h average systolic and diastolic bloo d pressures were 146.4 +/- 5.7 and 97.5 +/- 3.6 mmHg in renovascular a nd 144.3 +/- 1.2 and 98.0 +/- 2.2 mmHg in essential hypertensive patie nts. The angiotensin converting enzyme inhibitor treatment reduced 24 h average systolic and diastolic blood pressures by 8.5% and 9.7% in t he renovascular and by 8.3% and 10.8% in the essential hypertensive gr oup, Greater systolic and diastolic blood pressure reductions (-18.2% and -18.1%) were observed in renovascular hypertensive patients after percutaneous transluminal renal angioplasty, Blood pressure fell by ab out 10% during the night and the fall was similar in renovascular and in essential hypertensive patients. in the former group, nocturnal hyp otension was similar after washout, during angiotensin converting enzy me inhibitor treatment and after percutaneous transluminal renal angio plasty. Similar results were obtained for nocturnal bradycardia. Concl usions Nocturnal blood pressure fall is equally manifest in renovascul ar and essential hypertension, The removal of the renal artery stenosi s and blood pressure normalization do not enhance this phenomenon, Noc turnal hypotension seems therefore to be unaffected by renovascular hy pertension.