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Arterial stiffness in atherosclerotic renovascular hypertension

Fodor, Ljiljanaa; Premužić, Vedrana; Ivković, Vanjaa; Perkov, Draženb; Laganović, Marioa; Vrkić, Tajana Željkovića; Dika, Živkaa; Živko, Marijanaa; Jelaković, Bojana

doi: 10.1097/HJH.0000000000000324
ORIGINAL PAPERS: Renovascular hypertension

Objective: Arterial stiffness is an independent cardiovascular risk factor. Aging, high blood pressure and increased renin-angiotensin system activity contribute to increased arterial stiffness in patients with atherosclerotic renovascular hypertension (aRVH). A literature search failed to identify any study related to this topic. Therefore, our aim was to determine the arterial stiffness in patients with aRVH and analyze whether stenting in addition to multifactorial drug therapy has beneficial effects on markers of stiffness and the clinical course.

Methods: In this 6-month longitudinal study, 37 patients with refractory hypertension and unilateral aRVH were enrolled. After stenting, all patients received multifactorial dug therapy including 80 mg of telmisartan. Arterial stiffness indices were determined using Arteriograph. The control group consisted of 44 patients with essential hypertension.

Results: There were no differences in brachial blood pressure values between the two groups (P > 0.05). At baseline, adjusted pulse wave velocity (PWV) was higher in aRVH patients than that of essential hypertensive patients (12.8 ± 0.4 vs. 11.6 ± 0.3 m/s; P = 0.029). In the aRVH group, at the end of the follow-up, a significant decrease in the aortic augmentation index (37.7 ± 9.9 vs. 33.7 ± 11.4; P = 0.02) without changes in PWV was observed (P > 0.05).

Conclusion: This study is the first to show that arterial stiffness is higher in patients with refractory aRVH than in those with essential hypertension. Multifactorial therapy based on stenting and intensive medical treatment reduced central blood pressure and augmentation index. Failure to obtain PWV reduction is likely a consequence of the present irreversible structural vessel changes. Longer follow-up might enable us to resolve whether arterial stiffness indices have better predictive ability in patients with aRVH than brachial blood pressure.

aDepartment for Nephrology, Hypertension, Dialysis and Transplantation

bDepartment for Diagnostic and Interventional Radiology, University Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia

Correspondence to Bojan Jelaković, MD, PhD, Department for Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia, Kišpatićeva 12, Zagreb, Croatia. Tel: +385 1 23 88 271; e-mail: jelakovicbojan@gmail.com

Abbreviations: AIx, augmentation index; aRVH, atherosclerotic renovascular hypertension; BP, blood pressure; CKD, chronic kidney disease; MAP, mean arterial pressure; MDRD, Modification of Diet in Renal Disease; PWV, pulse wave velocity

Received 7 February, 2014

Revised 30 June, 2014

Accepted 1 July, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins