http://repub.eur.nl/res/aut/1440/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/9304/ 2000-01-01T00:00:00Z BACKGROUND: Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood. METHODS: We randomly assigned 106 patients with hypertension who had atherosclerotic renal-artery stenosis (defined as a decrease in luminal diameter of 50 percent or more) and a serum creatinine concentration of 2.3 mg per deciliter (200 micromol per liter) or less to undergo percutaneous transluminal renal angioplasty or to receive drug therapy. To be included, patients also had to have a diastolic blood pressure of 95 mm Hg or higher despite treatment with two antihypertensive drugs or an increase of at least 0.2 mg per deciliter (20 micromol per liter) in the serum creatinine concentration during treatment with an angiotensin-converting-enzyme inhibitor. Blood pressure, doses of antihypertensive drugs, and renal function were assessed at 3 and 12 months, and patency of the renal artery was assessed at 12 months. RESULTS: At base line, the mean (+/-SD) systolic and diastolic blood pressures were 179+/-25 and 104+/-10 mm Hg, respectively, in the angioplasty group and 180+/-23 and 103+/-8 mm Hg, respectively, in the drug-therapy group. At three months, the blood pressures were similar in the two groups (169+/-28 and 99+/-12 mm Hg, respectively, in the 56 patients in the angioplasty group and 176+/-31 and 101+/-14 mm Hg, respectively, in the 50 patients in the drug-therapy group; P=0.25 for the comparison of systolic pressure and P=0.36 for the comparison of diastolic pressure between the two groups); at the time, patients in the angioplasty group were taking 2.1+/-1.3 defined daily doses of medication and those in the drug-therapy group were taking 3.2+/-1.5 daily doses (P<0.001). In the drug-therapy group, 22 patients underwent balloon angioplasty after three months because of persistent hypertension despite treatment with three or more drugs or because of a deterioration in renal function. According to intention-to-treat analysis, at 12 months, there were no significant differences between the angioplasty and drug-therapy groups in systolic and diastolic blood pressures, daily drug doses, or renal function. CONCLUSIONS: In the treatment of patients with hypertension and renal-artery stenosis, angioplasty has little advantage over antihypertensive-drug therapy. http://repub.eur.nl/res/pub/9407/ 2000-01-01T00:00:00Z PURPOSE: To perform a meta-analysis of renal arterial stent placement in comparison with renal percutaneous transluminal angioplasty (PTA) in patients with renal arterial stenosis. MATERIALS AND METHODS: Studies dealing with renal arterial stent placement (14 articles; 678 patients) and renal PTA (10 articles; 644 patients) published up to August 1998 were selected. A random-effects model was used to pool the data. RESULTS: Renal arterial stent placement proved highly successful, with an initial adequate performance in 98% and major complications in 11%. The overall cure rate for hypertension was 20%, whereas hypertension was improved in 49%. Renal function improved in 30% and stabilized in 38% of patients. The restenosis rate at follow-up of 6-29 months was 17%. Stent placement had a higher technical success rate and a lower restenosis rate than did renal PTA (98% vs 77% and 17% vs 26%, respectively; P <.001). The complication rate was not different between the two treatments. The cure rate for hypertension was higher and the improvement rate for renal function was lower after stent placement than after renal PTA (20% vs 10% and 30% vs 38%, respectively; P <.001). CONCLUSION: Renal arterial stent placement is technically superior and clinically comparable to renal PTA alone. http://repub.eur.nl/res/pub/20073/ 1999-12-02T00:00:00Z If essential hypertension is a disease of theories, then renovascular hypertension is a disease of experiments. No other form of experimental hypertension has been more widely studied. The pathophysiology of renovascular hypertension is known in great detail. The question, however, of how to translate the experimental knowledge into clinical practice is a different matter, and the answer is far from clear. The main difficulty is that renovascular hypertension in experimental animals is not the same as hypertension associated with renal artery stenosis in humans. Renal artery stenosis in humans is in most cases caused by atherosclerosis, a progressive disease quite different from the silver clip in experimental animals. In the kidney, atherosclerosis does not only affect the large arteries but also the small arteries and arterioles. Furthermore, atherosclerosis is not limited to the kidney, it also affects the heart and the brain. There is no cure for atherosclerosis; restenosis after angioplasty is still a daunting problem. Finally, renal artery stenosis can be a complication of essential hypertension or essential hypertension can coincide with renovascular hypertension. Renal artery stenosis may cause severe and refractory hypertension and it frequently does so. This will lead to multiple organ damage such as hypertensive retinopathy, left ventricular hypertrophy, coronary vascular disease, heart failure and cerebrovascular accident? Progression of renal artery stenosis to renal artery occlusion results in loss of kidney function, and, in case of bilateral renal artery involvement or in the presence of atherosclerotic disease of smaller renal arteries, it will lead to end-stage renal failure.