Efficacy of 24-Hour Blood Pressure Monitoring in Evaluating Response to Percutaneous Transluminal Renal Angioplasty

• Published in: Circulation Journal Vol. 80; no. 9; pp. 1922 - 1930
• Main Authors: Jujo, Kentaro, Saito, Katsumi, Ishida, Issei, Furuki, Yuho, Ouchi, Taisuke, Kim, Ahsung, Suzuki, Yuki, Sekiguchi, Haruki, Yamaguchi, Junichi, Ogawa, Hiroshi, Hagiwara, Nobuhisa
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2016
• Subjects: Aged; Angioplasty; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Coronary Angiography; Female; Humans; Hypertension; Male; Peripheral artery disease; Renal; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - physiopathology; Renal Artery Obstruction - surgery
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-16-0347

Background:Percutaneous transluminal renal angioplasty (PTRA) improves patency in atherosclerotic renal artery stenosis (ARAS), but improvement in clinic blood pressure (BP) is seen in only 20–40% of patients who undergo PTRA. This study investigated the effects of PTRA on BP lowering, assessed on 24-h ambulatory BP monitoring (ABPM), and identified preoperative features predictive of satisfactory BP improvement after PTRA.Methods and Results:Of 1,753 consecutive patients undergoing coronary angiography, 31 patients with angiographically significant ARAS and translesional pressure gradient (TLPG) >20 mmHg underwent PTRA. ABPM was performed before, at 1 month and at 1 year after PTRA; patients with average systolic ABPM-BP decrease >10 mmHg at 1 month from baseline were categorized as responders. There was no obvious relationship between clinic BP and ABPM-BP at baseline. ABPM-BP was significantly higher in responders at baseline (SBP: 148 vs. 126 mmHg, P<0.01) and was improved 1 month after PTRA. This difference persisted until 1 year after PTRA. Night-time BP improved more than daytime BP in responders. Patients with higher baseline ABPM-BP achieved a larger decrease in ABPM-BP, but the severity of stenosis reflected by TLPG; renal duplex findings; and neurohumoral parameters other than baseline renal function, did not differ between the groups.Conclusions:Clinic BP does not represent daily hemodynamic status, whereas high ABPM-BP is a potent predictor of satisfactory BP response to PTRA. (Circ J 2016; 80: 1922–1930)