Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical interventions

• Published in: Pediatric nephrology (Berlin, West) Vol. 39; no. 2; pp. 521 - 530
• Main Authors: Redhead, Emily C. G., Paessler, Alicia, Arslan, Zainab, Patel, Premal, Minhas, Kishore, Forman, Colin, Hollis, Paolo, Lava, Sebastiano, Ionescu, Florin, Manuel, Devi, Ray, Samiran, Kessaris, Nicos, Giardini, Alessandro, Ratnamma, Vineetha, Dobby, Nadine, Tullus, Kjell, Simmonds, Jacob, Stojanovic, Jelena
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2024; Springer Nature B.V
• Subjects: Aldosterone; Angiotensin; Antihypertensive Agents; Antihypertensives; Blood pressure; Blood Pressure - physiology; Cardiovascular system; Child; Children; Congestive heart failure; Echocardiography; Humans; Hypertension; Hypertension, Renovascular - etiology; Hypertension, Renovascular - surgery; Intervention; Medicine; Medicine & Public Health; Nephrology; Original; Original Article; Parenchyma; Pediatrics; Renal artery; Renin; Retrospective Studies; Standard scores; Stenosis; Urology; Ventricle; Ventricular Remodeling; What’s new in Hypertension; Hypertension; Paediatric; Angioplasty; Cardiac
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-023-06123-5

Background Renovascular hypertension (RenoVH) is a cause of hypertension in children. A common cause of RenoVH is renal artery stenosis which acts by reducing blood supply to renal parenchyma and activating the renin–angiotensin–aldosterone axis, often leading to cardiac remodelling. This longitudinal observational study aims to describe occurrence of cardiovascular changes secondary to RenoVH and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention. Methods All patients with RenoVH referred to our centre, who received ≥ 1 endovascular intervention (some had also undergone surgical interventions) were included. Data were collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure and eight echocardiographic parameters pre- and post-intervention. Results One hundred fifty-two patients met inclusion criteria and had on average two endovascular interventions; of these children, six presented in heart failure. Blood pressure (BP) control was achieved by 54.4% of patients post-intervention. Average z -scores improved in interventricular septal thickness in diastole (IVSD), posterior Wall thickness in diastole (PWD) and fractional shortening (FS); left ventricular mass index (LVMI) and relative wall thickness (RWT) also improved. PWD saw the greatest reduction in mean difference in children with abnormal ( z -score reduction 0.25, p  < 0.001) and severely abnormal ( z -score reduction 0.23, p  < 0.001) z -scores between pre- and post-intervention echocardiograms. Almost half (45.9%) had reduction in prescribed antihypertensive medications, and 21.3% could discontinue all antihypertensive therapy. Conclusions Our study reports improvement in cardiac outcomes after endovascular + / − surgical interventions. This is evidenced by BP control, and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information. Supplementary information