Key result
Hyperemic systolic gradient ≥21 mm Hg linked to ~39% higher odds of post-stenting hypertension improvement.
Why the study?
The degree of renal artery stenosis that justifies stenting and predicts hypertension improvement is unknown.
Does a hyperemic systolic gradient ≥21 mm Hg predict hypertension improvement after stenting in patients with renal artery stenosis?
Cohort (n=62)
Does a hyperemic systolic gradient ≥21 mm Hg predict hypertension improvement after stenting in patients with renal artery stenosis?
Odds Ratio: 1.39 (95% CI 1.05–1.65)
Absolute Event Rate: 84% vs 36%
p-value: p=0.013
A hyperemic systolic gradient ≥21 mm Hg measured by pressure guidewire accurately predicts hypertension improvement after stenting for renal artery stenosis.
OBJECTIVES: We investigated the comparative accuracy of renal translesional pressure gradients (TPG), intravascular ultrasound (IVUS), and angiographic parameters in predicting hypertension improvement after stenting of renal artery stenosis (RAS). BACKGROUND: The degree of RAS that justifies stenting is unknown. METHODS: In 62 patients with RAS, TPG (resting and hyperemic systolic gradient [HSG], fractional flow reserve, and mean gradient) were measured by a pressure guidewire; IVUS and angiographic parameters (minimum lumen area and diameter, area stenosis, and diameter stenosis) were measured by quantitative analyses. RESULTS: The HSG had a larger area under the curve than most other parameters and an HSG >or=21 mm Hg had the highest sensitivity, specificity, and accuracy (82%, 84%, and 84%, respectively) in predicting hypertension improvement after stenting of RAS. The average IVUS area stenosis was markedly greater in RAS with an HSG >or=21 mm Hg versus <21 mm Hg (78% vs. 38%, respectively; p < 0.001). After stenting, hypertension improved in 84% of patients with an HSG >or=21 mm Hg (n = 36) versus 36% of patients with an HSG <21 mm Hg (n = 26) at 12 months, p < 0.01; the number of antihypertensive medications was significantly lower in patients with an HSG >or=21 mm Hg versus <21 mm Hg (2.30 +/- 0.90 vs. 3.40 +/- 0.50, respectively; p < 0.01). By multivariable analysis, HSG was the only independent predictor of hypertension improvement (odds ratio: 1.39; 95% confidence interval: 1.05 to 1.65; p = 0.013). CONCLUSIONS: An HSG >or=21 mm Hg provided the highest accuracy in predicting hypertension improvement after stenting of RAS, suggesting that an HSG >or=21 mm Hg is indicative of significant RAS.
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Leesar et al. (2009) conducted a cohort in Renal artery stenosis (n=62). Hyperemic systolic gradient ≥21 mm Hg vs. Hyperemic systolic gradient <21 mm Hg was evaluated on Hypertension improvement at 12 months (OR 1.39, 95% CI 1.05 to 1.65, p=0.013). A hyperemic systolic gradient ≥21 mm Hg independently predicted hypertension improvement 12 months after renal artery stenting (84% vs 36% for <21 mm Hg; OR 1.39; 95% CI 1.05-1.65; P=0.013).
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