Increased cardiovascular mortality in hypertensive patients with renal artery stenosis. Relation to sympathetic activation, renal function and treatment regimens

Background Previous studies in hypertensive patients with renovascular dise ase have shown both elevated sympathetic nerve activity and increased cardi ovascular mortality. Objective The aim of the present study was to assess long-term survival in hypertensive patients with renal artery stenosis in relation to sympathetic activation, renal function and treatment regimens. Subjects and methods A total of 169 consecutive patients aged 54 +/- 1 year s with hypertension underwent a clinical investigation for renovascular hyp ertension including renal angiography and measurement of bilateral renal re nin secretion. In 107 of these patients, arterial plasma concentrations of noradrenaline were measured. The mean follow-up time was 7.1 +/- 0.3 years and survival data were available in all patients up to May 1997. For compar ison, healthy age-matched normotensive controls were examined. Results Arterial noradrenaline concentrations were threefold elevated in hy pertensive patients with renal artery stenosis compared to healthy controls (P < 0.01). During the follow-up time, 44 patients died. Cardiovascular mo rtality accounted for 75% of all deaths. The risk ratio for overall mortali ty in hypertensive patients with renal artery stenosis compared to the norm al population of Sweden, matched for age, was 3.3 (2.4-4.4), whereas the ri sk ratio for cardiovascular mortality was 5.7 (3.9-8.0). The arterial plasm a concentration of noradrenaline was 3.11 +/- 0.30 pmol/ml in patients who died compared to 3.84 +/- 0.26 pmol/ml in survivors. Reduced renal function and age were independent predictors of death. Survival did not differ betw een patients undergoing intervention with either renal angioplasty or surgi cal reconstruction for renal artery stenosis and patients not undergoing in tervention. Conclusions Although sympathetic nerve activity is elevated in hypertensive patients with renal artery stenosis, our results do not suggest that this adrenergic over-activity is directly linked to the observed high cardiovasc ular mortality. Mortality in hypertensive patients with renovascular diseas e remains high whether an interventional treatment is performed or not, pos sibly due to the concomitant coronary disease. J Hypertens 1999, 17:1743-17 50 (C) Lippincott Williams & Wilkins.