Assessing outcomes to determine whether symptoms related to hypertension justify renal artery stenting

J. Gregory Modrall, Eric B. Rosero, Carlos H. Timaran, Thomas Anthony, Jayer Chung, R. James Valentine, Clayton Trimmer

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: The goal of the study was to determine the blood pressure (BP) response to renal artery stenting (RAS) for patients with hypertension urgency, hypertension emergency, and angina with congestive heart failure (angina/congestive heart failure [CHF]). Methods: Patients who underwent RAS for hypertension emergencies (n = 13), hypertension urgencies (n = 25), and angina/CHF (n = 14) were included in the analysis. By convention, hypertension urgency was defined by a sustained systolic BP < 180 mm Hg or diastolic BP < 120 mm Hg, while the definition of hypertension emergency required the same BP parameters plus hypertension-related symptoms prompting hospitalization. Patient-specific response to RAS was defined according to modified American Heart Association reporting guidelines. Results: The study cohort of 52 patients had a median age of 66 years (interquartile range 58-72). The BP response to RAS varied significantly according to the indication for RAS. Hypertension emergency provided the highest BP response rate (85%), while the response rate was significantly lower for hypertension urgency (52%) and angina/CHF (7%; P =.03). Only 1 of 14 patients with angina/CHF was a BP responder. Multivariate analysis showed that hypertension urgency or emergency were not independent predictors of BP response to RAS. Instead, the only independent predictor of a favorable BP response was the number of preoperative antihypertensive medications (odds ratio 7.5; 95% confidence interval 2.5-22.9; P =.0004), which is another indicator of the severity of hypertension. Angina/CHF was an independent predictor of failure to respond to RAS (odds ratio 118.6; 95% confidence interval 2.8-999.9; P =.013). Conclusions: Hypertension urgency and emergency are clinical manifestations of severe hypertension, but the number of preoperative antihypertensive medications proved to be a better predictor of a favorable BP response to RAS. In contrast, angina/CHF was a predictor of failure to respond to stenting, providing further evidence against the practice of incidental stenting during coronary interventions.

Original languageEnglish (US)
Pages (from-to)413-420
Number of pages8
JournalJournal of Vascular Surgery
Volume55
Issue number2
DOIs
StatePublished - Feb 2012

Fingerprint

Renal Artery
Hypertension
Blood Pressure
Heart Failure
Emergencies
Antihypertensive Agents
Odds Ratio
Confidence Intervals
Hospitalization
Cohort Studies
Multivariate Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Assessing outcomes to determine whether symptoms related to hypertension justify renal artery stenting. / Modrall, J. Gregory; Rosero, Eric B.; Timaran, Carlos H.; Anthony, Thomas; Chung, Jayer; Valentine, R. James; Trimmer, Clayton.

In: Journal of Vascular Surgery, Vol. 55, No. 2, 02.2012, p. 413-420.

Research output: Contribution to journalArticle

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abstract = "Objective: The goal of the study was to determine the blood pressure (BP) response to renal artery stenting (RAS) for patients with hypertension urgency, hypertension emergency, and angina with congestive heart failure (angina/congestive heart failure [CHF]). Methods: Patients who underwent RAS for hypertension emergencies (n = 13), hypertension urgencies (n = 25), and angina/CHF (n = 14) were included in the analysis. By convention, hypertension urgency was defined by a sustained systolic BP < 180 mm Hg or diastolic BP < 120 mm Hg, while the definition of hypertension emergency required the same BP parameters plus hypertension-related symptoms prompting hospitalization. Patient-specific response to RAS was defined according to modified American Heart Association reporting guidelines. Results: The study cohort of 52 patients had a median age of 66 years (interquartile range 58-72). The BP response to RAS varied significantly according to the indication for RAS. Hypertension emergency provided the highest BP response rate (85{\%}), while the response rate was significantly lower for hypertension urgency (52{\%}) and angina/CHF (7{\%}; P =.03). Only 1 of 14 patients with angina/CHF was a BP responder. Multivariate analysis showed that hypertension urgency or emergency were not independent predictors of BP response to RAS. Instead, the only independent predictor of a favorable BP response was the number of preoperative antihypertensive medications (odds ratio 7.5; 95{\%} confidence interval 2.5-22.9; P =.0004), which is another indicator of the severity of hypertension. Angina/CHF was an independent predictor of failure to respond to RAS (odds ratio 118.6; 95{\%} confidence interval 2.8-999.9; P =.013). Conclusions: Hypertension urgency and emergency are clinical manifestations of severe hypertension, but the number of preoperative antihypertensive medications proved to be a better predictor of a favorable BP response to RAS. In contrast, angina/CHF was a predictor of failure to respond to stenting, providing further evidence against the practice of incidental stenting during coronary interventions.",
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