Objective: Fibromuscular Dysplasia (FMD) is the second most frequent cause of renovascular hypertension. Percutaneous transluminal renal angioplasty (PTRA) is considered the first-line treatment in this condition. As of today, the main source of evidence on PTRA in patients with FMD is the meta-analysis of Trinquart et al. (Hypertension. 2010;56:525–32), which includes mostly studies performed in Caucasians before 2000, with ∼30% of patients still treated with surgery. The aim of the current meta-analysis was to reassess efficacy, safety and determinants of response to PTRA in more recent cohorts including more ethnically diverse patients, treated by contemporary revascularization techniques, with emphasis on the differences between Asian and Caucasian patients. Design and method: Seven databases were systematically searched for clinical studies published since 2000 reporting PTRA outcomes in FMD. A meta-analysis was performed using random-effects models. The protocol was registered in PROSPERO (CRD420250652382) and reporting followed the MOOSE guideline. Results: Twenty-nine studies (1470 patients) were included: 15 Asian (n=823) and 14 Caucasian (n=647). The overall pooled hypertension cure rate was 29.6%. In subgroup analyses, hypertension cure was significantly higher in Asians (40% vs 17%; P<0.001). Cure or improvement tended to be higher in Asians (90% vs 78%; P=0.08). Systolic blood pressure (BP) reduction tended to be greater (-33 vs -23 mmHg; P=0.08), and diastolic BP reduction was significantly greater in Asians (-21 vs -11 mmHg; P=0.016). Decrease in in antihypertensive drugs (-1.1 vs -0.8; P=0.10), technical success (97% vs 99%; P=0.25), and restenosis (20% vs 19%; P=0.96) were similar. Overall reported periprocedural complications were more frequent in Caucasians (12% vs 1%; P=0.01). In meta-regression, younger age and a higher proportion of men were associated with hypertension cure in univariable analyses. However, when both variables were included in a multivariable model, only age remained independently predictive of outcome. Conclusions: PTRA shows comparable safety and procedural success in Asian and Caucasian patients with renal FMD, while reported BP responses are more favorable in Asians. Age independently predicts hypertension cure, underscoring the importance of early diagnosis and timely intervention.
Wang et al. (Fri,) studied this question.