gms | German Medical Science

27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga

Deutsche Liga zur Bekämpfung des hohen Blutdrucks – Deutsche Hypertonie Gesellschaft e. V.

26. bis 29.11.2003, Bonn

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Intrarenal Doppler with ACE-I in patients with unilateral renal artery stenosis: a predictor for improvement of hypertension?

Intrarenaler Doppler mit ACE-Hemmer bei unilateraler Nierenarterienstenose: ein Prädiktor für die Verbesserung der Hypertonie?

Meeting Abstract (Hypertonie 2003)

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  • presenting/speaker A. Voiculescu
  • M. Schmitz
  • J. Plum
  • S. Vupora
  • G. Jung
  • U. Mödder
  • T. Pfeiffer
  • W. Sandmann
  • B. Grabensee

Hypertonie 2003. 27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga. Bonn, 26.-29.11.2003. Düsseldorf, Köln: German Medical Science; 2004. Doc03hochV23

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/hoch2003/03hoch023.shtml

Published: November 11, 2004

© 2004 Voiculescu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Introduction

The key question for the treatment of renal artery stenosis (RAS) is whether hypertension (HT) can be improved after intervention. Therefore, we investigated intrarenal hemodynamic changes after ACE-I with colour coded Duplex sonography (CDS) in patients with RAS. We postulated that patients with sustained vascular reactivity measured with CDS would be those who improve with HT.

Methods

From 1/2001 to 6/2003 patients with angiographically proven unilateral RAS >70% were studied before and 3-6 months after intervention. Surgery or angioplasty was planned in dependence of the morphology of the stenosis. In all patients 24 h blood pressure (RR) was obtained. With CDS resistance indices (RI) in interlobar arteries of both kidneys were determined before and 30 min. after i. v. 1,25 mg Enalaprilat. For evaluation of the improvement of HT a score, including mean arterial pressure (MAD) and number of antihypertensive agents (MED), was assessed: (MADx(1+MED/10). Improvement of HT was defined as a decrease of >20 in score.

Results

33 patients (60±12.8 years) were studied before and after intervention (5.8±3.6 months). RRsys. decreased from142±15 mmHg to 132±17 and RRdiast. from 80±11 to 76±12 (p<0.05). Based on the named criteria for improvement of HT 13 patients were identified with profit (MAD Score before 144±17, after 105±16) and 20 patients without profit (MAD score before 124±15, after 119±17. Patients with profit had lower RI´s in the stenosed kidney and revealed a pronounced decrease of RI on the side with stenosis after ACE-I. RI on the contralateral side was not different (0.65±0.07 vs. 0.70±0.09). Intrarenal CDS parameters are presented in tab. 1 [Tab. 1].

Conclusion

Intrarenal Doppler flow characteristics before and after ACE-I seem to provide information on vascular reactivity and could therefore be useful as predictors for improvement of HT after intervention of RAS.