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Titolo:
Resistance to anti hypertensive medication as predictor of renal artery stenosis: comparison of two drug regimens
Autore:
van Jaarsveld, BC; Krijnen, P; Derkx, FHM; Deinum, J; Woittiez, AJJ; Postma, CT; Schalekamp, MADH;
Indirizzi:
Univ Rotterdam Hosp, Dept Internal Med, Rotterdam, Netherlands Univ Rotterdam Hosp Rotterdam Netherlands l Med, Rotterdam, Netherlands
Titolo Testata:
JOURNAL OF HUMAN HYPERTENSION
fascicolo: 10, volume: 15, anno: 2001,
pagine: 669 - 676
SICI:
0950-9240(200110)15:10<669:RTAHMA>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY; RENOVASCULAR HYPERTENSION; CAPTOPRIL RENOGRAPHY; BLOOD-PRESSURE; DIAGNOSIS; DISEASE; LIMITATIONS;
Keywords:
renovascular hypertension; renal artery stenosis; diagnostic test; drug-resistance;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
21
Recensione:
Indirizzi per estratti:
Indirizzo: van Jaarsveld, BC Dianet Dialysis Ctr, Brennerbaan 130, NL-3524 BN Utrecht, Netherlands Dianet Dialysis Ctr Brennerbaan 130 Utrecht Netherlands NL-3524 BN
Citazione:
B.C. van Jaarsveld et al., "Resistance to anti hypertensive medication as predictor of renal artery stenosis: comparison of two drug regimens", J HUM HYPER, 15(10), 2001, pp. 669-676

Abstract

Background. Renal artery stenosis is among the most common curable causes of hypertension. The definitive diagnosis is made by renal angiography, an invasive and costly procedure. The prevalence of renal artery stenosis is less than 1% in non-selected hypertensive patients but is higher when hypertension is resistant to drugs. Objective: To study the usefulness of standardised two-drug regimens for identifying drug-resistant hypertension as a predictor of renal artery stenosis. Design and setting. Prospective cohort study carried out in 26 hospitals in The Netherlands. Patients: Patients had been referred for analysis of possible secondary hypertension or because hypertension was difficult to treat. Patients less than or equal to 40 years of age were assigned to either amiodipine 10 mg or enalapril 20 mg, and patients >40 years to either amiodipine 10 mg combinedwith atenolol 50 mg or to enalapril 20 mg combined with hydrochlorothiazide 25 mg. Renal angiography was performed: (1) if hypertension was drug-resistant, ie if diastolic pressure remained greater than or equal to 95 mm Hg at three visits 1-3 weeks apart or an extra drug was required, and/or (2) if serum creatinine rose by greater than or equal to 20 mu mol/L (greater than or equal to0.23 mg/dL) during ACE inhibitor treatment. Results: Of the 1106 patients with complete follow-up, 1022 had been assigned to either the amiodipine- or enalapril-based regimens, 772 by randomisation. Drug-resistant hypertension, as defined above, was identified in 41% of the patients, and 20% of these had renal artery stenosis. Renal functionimpairment was observed in 8% of the patients on ACE inhibitor, and this was associated with a 46% prevalence of renal artery stenosis. in the randomised patients, the prevalence of renal artery stenosis did not differ between the amiodipine- and enalapril-based regimens. Conclusions: In the diagnostic work-up for renovascular hypertension the use of standardised medication regimens of maximally two drugs, to identify patients with drug-resistant hypertension, is a rational first step to increase the a priori chance of renal artery stenosis. Amiodipine- or enalapril-based regimens are equally effective for this purpose.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/09/20 alle ore 09:49:49