The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group.
The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group.
复制标题
球囊血管成形术对动脉粥样硬化性肾动脉狭窄高血压的影响。
DOI：
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复制
发表时间：
2000
影响因子：
158.5
通讯作者：
M. Schalekamp
中科院分区：
文献类型：
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作者：
B. V. Jaarsveld;P. Krijnen;H. Pieterman;F. Derkx;J. Deinum;C. Postma;A. Dees;A. Woittiez;A. Bartelink;A. Veld;M. Schalekamp
背景
高血压和肾动脉狭窄的患者通常采用经皮腔内肾血管成形术治疗。然而，这一过程对血压的长期影响还不是很清楚。
方法
我们随机将106名有动脉粥样硬化性肾动脉狭窄(定义为管腔内径缩小50%或以上)且血清肌酐浓度在2.3毫克/分升(200微摩尔/升)以下的高血压患者分配到接受经皮腔内肾血管成形术或接受药物治疗的患者。纳入研究的患者还必须有95毫米汞柱或更高的舒张压，尽管患者接受了两种降压药的治疗，或者在血管紧张素转换酶抑制剂治疗期间，每分升血清肌酐浓度至少增加了0.2毫克(每升20微摩尔)。在3个月和12个月时评估血压、抗高血压药物的剂量和肾功能，并在12个月时评估肾动脉的通畅性。
结果
在基线下，血管成形术组的平均(+/-SD)收缩压和舒张压分别为179+/-25和104+/-10 mm Hg，药物治疗组分别为180+/-23和103+/-8 mm Hg。3个月时两组血压相近(血管成形组56例，分别为169+/-28和99+/-12 mm Hg；药物治疗组50例，分别为176+/-31和101+/-14 mm Hg；两组间收缩压比较P=0.25，舒张压比较P=0.36)；当时，血管成形术组的患者每天服用2.1%+/-1.3量的药物，药物治疗组的患者每天服用3.2%+/-1.5量的药物(P<；0.001)。在药物治疗组中，22名患者在三个月后接受了球囊血管成形术，原因是尽管接受了三种或更多的药物治疗，但仍有持续性高血压，或者因为肾功能恶化。根据意向处理分析，在12个月时，血管成形术组和药物治疗组在收缩压和舒张压、每日药物剂量或肾功能方面没有显著差异。
结论
在高血压和肾动脉狭窄患者的治疗中，血管成形术并不比抗高血压药物治疗有多少优势。
BACKGROUND
Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood.
METHODS
We randomly assigned 106 patients with hypertension who had atherosclerotic renal-artery stenosis (defined as a decrease in luminal diameter of 50 percent or more) and a serum creatinine concentration of 2.3 mg per deciliter (200 micromol per liter) or less to undergo percutaneous transluminal renal angioplasty or to receive drug therapy. To be included, patients also had to have a diastolic blood pressure of 95 mm Hg or higher despite treatment with two antihypertensive drugs or an increase of at least 0.2 mg per deciliter (20 micromol per liter) in the serum creatinine concentration during treatment with an angiotensin-converting-enzyme inhibitor. Blood pressure, doses of antihypertensive drugs, and renal function were assessed at 3 and 12 months, and patency of the renal artery was assessed at 12 months.
RESULTS
At base line, the mean (+/-SD) systolic and diastolic blood pressures were 179+/-25 and 104+/-10 mm Hg, respectively, in the angioplasty group and 180+/-23 and 103+/-8 mm Hg, respectively, in the drug-therapy group. At three months, the blood pressures were similar in the two groups (169+/-28 and 99+/-12 mm Hg, respectively, in the 56 patients in the angioplasty group and 176+/-31 and 101+/-14 mm Hg, respectively, in the 50 patients in the drug-therapy group; P=0.25 for the comparison of systolic pressure and P=0.36 for the comparison of diastolic pressure between the two groups); at the time, patients in the angioplasty group were taking 2.1+/-1.3 defined daily doses of medication and those in the drug-therapy group were taking 3.2+/-1.5 daily doses (P<0.001). In the drug-therapy group, 22 patients underwent balloon angioplasty after three months because of persistent hypertension despite treatment with three or more drugs or because of a deterioration in renal function. According to intention-to-treat analysis, at 12 months, there were no significant differences between the angioplasty and drug-therapy groups in systolic and diastolic blood pressures, daily drug doses, or renal function.
CONCLUSIONS
In the treatment of patients with hypertension and renal-artery stenosis, angioplasty has little advantage over antihypertensive-drug therapy.
卡托普利肾图诊断肾动脉狭窄：准确性和局限性。
DOI：
10.1016/0002-9343(91)90503-p
发表时间：
1991
期刊：
The American journal of medicine
影响因子：
--
作者：
Mann,SJ;Pickering,TG;Sos,TA;Uzzo,RG;Sarkar,S;Friend,K;Rackson,ME;Laragh,JH
通讯作者：
Laragh,JH