Clinical predictors of improved long-term blood pressure control after successful stenting of hypertensive patients with obstructive renal artery atherosclerosis

Despite a high procedural success rate, long-term blood pressure control af ter successful renal artery stenting of hypertensive patients has been inco nsistent. This most likely reflects the absence of clinical guidelines for the selection of patients likely to benefit from renal revascularization, A cohort of 150 consecutive hypertensive patients (mean age, 66.7 years; 86 women) with 180 renal artery lesions (greater than or equal to 75%) underwe nt primary Palmaz stent deployment. Mean arterial blood pressure (MAP), ser um creatinine, and antihypertensive medication requirements were monitored prospectively. Specific definitions of blood pressure cure, improvement, or treatment failure were followed, Renal artery duplex Doppler or angiograph y was performed to assess stent patency at a mean 13 months (range, 7-15 mo nths). Multivariate logistic regression analysis was used to select clinica l variables that best related to a beneficial blood pressure control at fol low-up, The procedural success rate was 97.3% (146 patients) and major in-l aboratory complications were infrequent (1.3%), Late MAP values in 127 pati ents (91%) fell from 110 +/- 13.7 to 97.6 +/- 10.6 mm Hg (P < 0.001); antih ypertensive medication requirements decreased from 2.9 +/- 1.2 to 1.9 +/- 1 .1 (P < 0.01). The 13-month stent restenosis rate defined by duplex Doppler or angiography was 12%, Multivariate logistic regression analysis identifi ed a preprocedure MAP of >110 mm Hg (odds ratio, 2.9; P = 0.003) and bilate ral renal stenoses (odds ratio, 4.6; P = 0.009) as predictors of a benefici al blood pressure response at follow-up. This study provides general prepro cedure guidelines for the selection of hypertensive patients with atheroscl erotic renal lesions likely to benefit from primary Palmaz stenting and con firms a high procedural success and low stent restenosis rate, Cathet Cardi ovasc. Intervent 47:167-172, 1999. (C) 1999 Wiley-Liss, Inc.