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Clinical significance of low‐grade renal artery stenosis
Author(s) -
Dechering D. G.,
Kruis H. M. E.,
Adiyaman A.,
Thien Th.,
Postma C. T.
Publication year - 2010
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2009.02144.x
Subject(s) - medicine , hazard ratio , angina , cardiology , incidence (geometry) , stenosis , myocardial infarction , stroke (engine) , proportional hazards model , renal artery stenosis , cohort , renal artery , kidney , confidence interval , mechanical engineering , physics , optics , engineering
. Dechering DG, Kruis HME, Adiyaman A, Thien Th, Postma CT (Radboud University, Nijmegen, The Netherlands, and University Hospital Münster, Münster, Germany). Clinical significance of low‐grade renal artery stenosis. J Intern Med 2010; 267 : 305–315. Background. Patients with a renal artery stenosis (RAS) >50% carry an increased risk for future cardiovascular (CV) events. Experimental literature on this topic suggests that this might as well be true for subjects with lower‐grade RAS. Methods. Recruitment in this longitudinal cohort study was conducted from 1982 to 2002 in a Dutch University Hospital. Included in this study were 301 hypertensive patients clinically suspected of having RAS. Study participants were radiologically classified as having no, a low‐grade (<50% lumen narrowing) or high‐grade (≥50%) RAS. A predetermined composite CV end‐point was defined as one of the following: myocardial infarction or ‘objectified’ angina pectoris, ischaemic stroke or death from any CV cause. Other end‐points were the occurrence of CV complications, all‐cause plus CV mortality and decline in renal function. Results. During a median follow‐up of 8.2 years, the incidence of the composite end‐point totalled 79 events. After full adjustment in Cox models, a significant risk increase in high‐grade [hazard ratio (HR) 2.81; P = 0.002] and low‐grade RAS (HR 2.32; P = 0.038) was observed. Other end‐points did not differ significantly between study groups. Conclusion. Hypertensive subjects with RAS of any extent, compared with hypertensives without RAS, carry a substantially increased risk for future CV events. Therefore, even in patients with low‐grade RAS, aggressive pharmacological treatment strategies should be adopted as a preventive measure.