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Abstract

A meta-analysis of randomized controlled trials was performed to compare the effects of balloon angioplasty and medical therapy on blood pressure, use of antihypertensive drugs, renal function, arterial patency rates and complications in patients with anatomically significant renal artery stenosis.

MEDLINE, EMBASE, Science Citation Index, the Cochrane Controlled Trials Registry, and hand-searched reference lists were searched for randomized controlled trials including hypertensive patients with uni- or bilateral atherosclerotic renal artery stenosis greater than 50% with a follow-up of at least three months. Two investigators extracted data independently, and differences were resolved by consensus.

Three trials involving 210 patients met the inclusion criteria. Balloon angioplasty was significantly more effective in lowering blood pressure than medical therapy. The weighted mean difference was -6.5 mm Hg (95% CI -11.8 to -1.2) for systolic, and -3.2 mm Hg (95% CI -5.8 to -0.6) for diastolic blood pressure. There was no discordance between studies, as the chi-square test for heterogeneity did not exceed the number of degrees of freedom for either systolic and diastolic blood pressure. There were no significant differences in changes of renal function or the rate of renovascular complications between the two groups. Patients treated with balloon angioplasty were more likely to have patent renal arteries after 12 months (52 versus 19%, OR 4.2, 95% CI 1.8 - 9.8, n=91) and use less antihypertensive medication.

Balloon angioplasty should be advocated to improve blood pressure control in patients with difficult-to-treat hypertension and anatomically significant atherosclerotic renal artery stenosis. Whether the higher patency rate with balloon angioplasty prevents progressive loss of renal function is still unclear.

Meta-Analysis, Balloon Angioplasty, Renal Artery Stenosis
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© American Journal of Hypertension, Ltd. 2001
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