Preoperative clinical and renal ultrasonography variables associated with improved systolic and diastolic blood pressure reduction after renal artery stenting

IntroductionResponse to stent-assisted angioplasty (PTA) in hypertensive patients with atherosclerotic renal artery stenosis (ARAS) is unpredictable. Therefore, the present study aimed to search for preoperative clinical and renal ultrasonography variables associated with systolic (SBP) and diastolic blood pressure (DBP) reduction.Material and methodsPreoperative clinical assessment and renal ultrasonography were performed in 202 patients who underwent PTA for ARAS (2003–2018). Patients were categorized as responders if decrease of SBP of at least 20mmHg or DBP of 5mmHg was achieved. Logistic regression models, with percentage shares, were evaluated by basic decision characteristics for ultrasonographic and clinical variables.ResultsLogistic regression analysis showed that preoperative SBP ≥145mmHg (OR,20.0 [95%CI 8.67–46.2], p<0.001), (2) baseline DBP >82 mmHg (OR,3.46 [95%CI 1.61–7.42], p=0.001), (3) prior myocardial infarction (OR,3.14 [95%CI 1.09–9.0], p=0.033), and (4) Renal-Aortic-Ratio >5.1 (OR,2.67 [95%CI 1.20-6.0], p=0.016) predicted the SBP response, with respective influence shares of 69.8%; 12.1%; 10.9%; and 7.2%. The DBP response was associated with (1) baseline SBP >145mmHg (OR,3.79 [95%CI 1.87–7.70], p<0.001), (2) baseline DBP >82mmHg (OR,6.09 [95%CI 2.88–12.9], p<0.001), (3) ARAS progression (OR,0.32 [95%CI 0.09–1.07], p=0.062), (4) contralateral kidney length>106mm (OR,0.43 [95%CI 0.22–0.86], p=0.017), and (5) bilateral PTA (OR,2.39 [95%CI 1.08–5.27], p=0.03), with respective shares of 21.8%; 35.0%; 18.2%; 13.3% and 11.8%.ConclusionsCurrent study identified clinical and ultrasonographic characteristics of patients who are likely to respond to PTA for ARAS. The RAR and contralateral kidney size may enhance prediction of response likelihood.