CLINICAL TRIAL: STENTING WITH ANTI-HYPERTENSIVE MEDICAL THERAPY, COMPARED TO MED

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 中心，不一定是研究者的机构。 本研究旨在比较使用试验用器械PALMAZ GENESIS支架治疗肾动脉狭窄的安全性和有效性。 可能存在逻辑进展，其中由于RAS导致的肾缺血导致临床事件，例如缺血、神经内分泌激活、高血压和肾功能不全。 这些因素导致病理生理学改变，包括动脉粥样硬化加速、血栓形成增强、进一步肾功能障碍和左心室肥大的发展等。这些反过来导致临床事件，包括CHF、心肌梗死（MI）、卒中、进行性肾功能不全，最终导致死亡。 本研究的核心是一个基本问题，即针对一种或多种机制的抗高血压药物治疗是否足以中断这一过程，或者是否需要血运重建。 本研究还将研究导致临床事件的途径中的关键步骤，包括血压控制、肾功能和解剖狭窄，以了解这些关系是否存在。 因此，除了回答一个重要的临床问题外，这项研究还将增进我们对这种疾病的理解。 为了解决我们的研究结果的卫生政策和护理质量的影响，本研究将仔细研究这些替代治疗对生活质量和护理成本效益的影响。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This study is designed to compare the safety and effectiveness of treating renal artery stenosis with the use of an investigational device, the PALMAZ GENESIS Stent. There likely exists a logical progression wherein renal ischemia, due to RAS, leads to clinical events such as ischemia, neuroendocrine activation, hypertension, and renal insufficiency. These factors result in pathophysiologic alterations including acceleration of atherosclerosis, enhanced thrombosis, further renal dysfunction and development of left ventricular hypertrophy, amongst others. These in turn lead to clinical events including CHF, myocardial infarction (MI), stroke, progressive renal insufficiency, and ultimately death. At the heart of this study is the fundamental question of whether anti-hypertensive pharmacologic therapy, directed at 1 or several mechanisms, is sufficient to interrupt this process or whether revascularization is required. This study will also look at critical steps in the pathway leading to clinical events including BP control, renal function, and the anatomic stenosis to understand whether these relationships exist. Thus, beyond answering an important clinical question, the study will enhance our understanding of the disease. To address the health policy and quality of care implications of our findings, this study will carefully examine the impact of these alternative treatments on quality of life and cost-effectiveness of care.