The effect of percutaneous transluminal angioplasty for renovascular hypertension and the renin-angiotensin system

• Published in: Nihon Jinzo Gakkai shi Vol. 30; no. 10; pp. 1265 - 1271
• Main Authors: KOGA, TOKUSHI, UENO, MICHIO, TSUCHIHASHI, TAKUYA, TOMITA, YUJI, ABE, ISAO, MURATANI, HIROMI, TAKATA, YUTAKA, TAKISHITA, SHUICHI, KOBAYASHI, KAZUO, FUJISHIMA, MASATOSHI
• Format: Journal Article
• Language: Japanese
• Published: Japan Japanese Society of Nephrology 01.10.1988
• Subjects: Adult; Angioplasty, Balloon; Blood Pressure; Evaluation Studies as Topic; Female; Humans; Hypertension, Renovascular - physiopathology; Hypertension, Renovascular - therapy; Male; Middle Aged; percutaneous transluminal angioplasty; Renal Artery; Renin - blood; Renin-Angiotensin System; renovascular hypertension
• ISSN: 0385-2385; 1884-0728
• DOI: 10.14842/jpnjnephrol1959.30.1265

Perculaneous transluminal angioplasty (PTA) was attempted in 10 renal arteries of 9 patients with renovascular hypertension. Their arterial stenoses were considered to be due to atherosclerosis in 4 patients, fibromuscular dysplasia in 4, and other in one. The renal vein renin ratio exceeded 1.5 in all except one patient. Captopril induced a significant reduction in mean blood pressure by 12.3% and a significant increase in peripheral plasma renin activity (PRA). Angiotensin II analogue (AIIA) also significantly reduced the mean blood pressure by 6.8%. Angioplasty was technically successful in all patients except one with fibromuscular dysplasia. In six patients in whom antihypertensive medications were discontinued before angioplasty, blood pressure fell significantly from 171± 3/107±6 to 138±6/87±3 mmHg immediately after angioplasty. Peripheral PRA decreased from 6.1±1.7 to 2.8±1.0 ng/ml/hr. One patient who continued antihypertensive agents was able to reduce the dose of the drugs after angioplasty. In the remaining one patient who had a solitary functioning kidney with renal insufficiency, the level of serum creati-nine decreased immediately after angioplasty. During a follow-up period from 2 to 80 months, all of the three patients with fibromuscular dysplasia received long-term benefit namely normotension without drugs, while three of the four patients with atherosclerosis lost benefits within one year after angioplasty. No significant correlation was observed between the percent decrease in blood pressure by PTA and the profile of renin-angio-tensin system (peripheral PRA before PTA, renal vein renin ratio, both captopril-and AIIA- induced decrease in blood pressure and increase in peripheral PRA, and PTA-induced decrease in peripheral PRA). These results suggest that the profile of renin-angiotensin system may not be related directly to the percent decrease in blood pressure by PTA, and also that long-term effect of PTA is dissapointing in patients with atherosclerosis, although PTA produced short-term benefit is independent of the etiology of renovascular hypertension.