van Jaarsveld BC, Derkx FHM, Schalekamp MADH
The Dutch renal artery stenosis intervention cooperative study

Clin Hyp Nephrol (Calab) (Sep) : 1995

This is a prospective study on diagnosis and treatment of renovascular hypertension. The main issues are: 1) Which is the optimal strategy in patients with drug-resistant hypertension to diagnose a renal artery stenosis? 2) In a patient with a renal artery stenosis caused by atherosclerosis, is balloon angioplasty more effective for treating hypertension than antihypertensive drug treatment? Methods: New patients with hypertension are treated with two standard drug protocols:amlodipine 10 mg with atenolol 50 mg, or enalapril 20 mg with HCTZ 25 mg. In all patients who remainhypertensive on this regimen angiography is performed togethe r with renal scintigraphy, captoprilrenin challenge test and renal vein renin sampling. Patients with a renal artery stenosis of 50% ormore caused by atherosclerosis are then randomised for balloon angioplasty or medical treatment.

Results: 775 patients have been enrolled toá©ádate. The calcium- antagonist protocol seems to be more effective than the ACE-inhibitor regimen. In 288 patients arteriography was performed: 88 patients had a renal artery stenosis of 50% or more. Sensitivity of renal scintigraphy was about 70% and specificity was 80%. Specificity of the captopril challenge test was high (90%), but sensitivity was only 40%. Up to the present date, 72 patients have been randomised to either balloon angioplasty or medication. A very preliminary analysis on an intention-to-treat basis shows no significant difference in blood pressure or creatinine values at the present time. On the one-year follow-up arteriography, about half of the patients who have undergone balloon angioplasty had a relapse of their stenosis. We hope to give the definitive results of this prospective study on the effect of balloon angioplasty on hypertension 1-2 years from now. (authors)

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H: Special problems : Renovascular hypertension


Sir, I think one important question is the degree of function impairment of the kidney before revascularization is taken into consideration. This point was obviously not investigated in the present study.
Dr. Zerrenthin
Meiningen, - Sunday, December 05, 1999 at 09:36:45 (PST)