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Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis

Alhadad, Alaa LU ; Mattiasson, Ingrid LU ; Ivancev, Krassi LU ; Gottsäter, Anders LU and Lindblad, Bengt LU (2005) In Journal of Human Hypertension 19(10). p.761-767
Abstract
Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but longtime follow-up is lacking. Retrospective follow-up for 7.0 +/- 4.7 years of 69 consecutive patients ( age 44 +/- 13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge ( from 174 +/- 33/ 100 +/- 13 to 138 +/- 19/80 +/- 15 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last... (More)
Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but longtime follow-up is lacking. Retrospective follow-up for 7.0 +/- 4.7 years of 69 consecutive patients ( age 44 +/- 13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge ( from 174 +/- 33/ 100 +/- 13 to 138 +/- 19/80 +/- 15 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.0 +/- 4.7 years (140 +/- 25/83 +/- 12 mmHg; P<0.0001). Serum-creatinine had decreased both at 1 year ( from 84 +/- 28 to 75 +/- 13 mu mol/ l; P = 0.0030) and last follow-up (75 +/- 16 mu mol/ l; P = 0.0017). The number of antihypertensive drugs decreased ( from 2.3 +/- 1.2 before PTRA to 1.4 +/- 1.3 at discharge and at 1 month; P<0.0001, and 1.6 +/- 1.5 at last follow-up; P = 0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43 +/- 29 vs 20 +/- 41 mmHg; P = 0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.9 +/- 7.7 vs 1.8 +/- 4.1 years; P = 0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
surgical reconstruction, PTRA, fibromuscular dysplasia, renal artery, long-term follow-up
in
Journal of Human Hypertension
volume
19
issue
10
pages
761 - 767
publisher
Nature Publishing Group
external identifiers
  • wos:000232027300003
  • pmid:15920452
  • scopus:27144549290
ISSN
1476-5527
DOI
10.1038/sj.jhh.1001893
language
English
LU publication?
yes
id
0376064f-92e0-4d65-b624-8a6c84f925a6 (old id 223716)
date added to LUP
2007-08-23 11:36:36
date last changed
2017-10-22 03:40:07
@article{0376064f-92e0-4d65-b624-8a6c84f925a6,
  abstract     = {Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but longtime follow-up is lacking. Retrospective follow-up for 7.0 +/- 4.7 years of 69 consecutive patients ( age 44 +/- 13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge ( from 174 +/- 33/ 100 +/- 13 to 138 +/- 19/80 +/- 15 mmHg; P&lt;0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.0 +/- 4.7 years (140 +/- 25/83 +/- 12 mmHg; P&lt;0.0001). Serum-creatinine had decreased both at 1 year ( from 84 +/- 28 to 75 +/- 13 mu mol/ l; P = 0.0030) and last follow-up (75 +/- 16 mu mol/ l; P = 0.0017). The number of antihypertensive drugs decreased ( from 2.3 +/- 1.2 before PTRA to 1.4 +/- 1.3 at discharge and at 1 month; P&lt;0.0001, and 1.6 +/- 1.5 at last follow-up; P = 0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43 +/- 29 vs 20 +/- 41 mmHg; P = 0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.9 +/- 7.7 vs 1.8 +/- 4.1 years; P = 0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.},
  author       = {Alhadad, Alaa and Mattiasson, Ingrid and Ivancev, Krassi and Gottsäter, Anders and Lindblad, Bengt},
  issn         = {1476-5527},
  keyword      = {surgical reconstruction,PTRA,fibromuscular dysplasia,renal artery,long-term follow-up},
  language     = {eng},
  number       = {10},
  pages        = {761--767},
  publisher    = {Nature Publishing Group},
  series       = {Journal of Human Hypertension},
  title        = {Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis},
  url          = {http://dx.doi.org/10.1038/sj.jhh.1001893},
  volume       = {19},
  year         = {2005},
}