Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting.
<h4>Background</h4>In atherosclerotic renal artery disease, the benefit of revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital.<h4>Objectives</h4>To investigate whether this...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2019-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0218788 |
| _version_ | 1819112608355057664 |
|---|---|
| author | Florence Sens Gabrielle Normand Thomas Fournier Nellie Della-Schiava Stéphane Luong Caroline Pelletier Philip Robinson Sandrine Lemoine Olivier Rouvière Laurent Juillard |
| author_facet | Florence Sens Gabrielle Normand Thomas Fournier Nellie Della-Schiava Stéphane Luong Caroline Pelletier Philip Robinson Sandrine Lemoine Olivier Rouvière Laurent Juillard |
| author_sort | Florence Sens |
| collection | DOAJ |
| description | <h4>Background</h4>In atherosclerotic renal artery disease, the benefit of revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital.<h4>Objectives</h4>To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal revascularization.<h4>Methods</h4>Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity >180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected.<h4>Results</h4>Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent revascularization, respectively. Patients assigned to revascularization presented a significant decrease in systolic blood pressure (-23±34mmHg, p = 0.007), diastolic blood pressure (-12±18mmHg, p = 0.007), number of antihypertensive medications (-1.00±1.03, p = 0.001), and number of uncontrolled or resistant hypertension (p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event.<h4>Conclusion</h4>Based on a multidisciplinary selection of revascularization indications, patients on whom a renal revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events. |
| first_indexed | 2024-12-22T04:16:13Z |
| format | Article |
| id | doaj.art-ac9da39976a340a98ed995aa40cd2c4f |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T04:16:13Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-ac9da39976a340a98ed995aa40cd2c4f2022-12-21T18:39:23ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01146e021878810.1371/journal.pone.0218788Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting.Florence SensGabrielle NormandThomas FournierNellie Della-SchiavaStéphane LuongCaroline PelletierPhilip RobinsonSandrine LemoineOlivier RouvièreLaurent Juillard<h4>Background</h4>In atherosclerotic renal artery disease, the benefit of revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital.<h4>Objectives</h4>To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal revascularization.<h4>Methods</h4>Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity >180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected.<h4>Results</h4>Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent revascularization, respectively. Patients assigned to revascularization presented a significant decrease in systolic blood pressure (-23±34mmHg, p = 0.007), diastolic blood pressure (-12±18mmHg, p = 0.007), number of antihypertensive medications (-1.00±1.03, p = 0.001), and number of uncontrolled or resistant hypertension (p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event.<h4>Conclusion</h4>Based on a multidisciplinary selection of revascularization indications, patients on whom a renal revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events.https://doi.org/10.1371/journal.pone.0218788 |
| spellingShingle | Florence Sens Gabrielle Normand Thomas Fournier Nellie Della-Schiava Stéphane Luong Caroline Pelletier Philip Robinson Sandrine Lemoine Olivier Rouvière Laurent Juillard Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting. PLoS ONE |
| title | Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting. |
| title_full | Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting. |
| title_fullStr | Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting. |
| title_full_unstemmed | Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting. |
| title_short | Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting. |
| title_sort | blood pressure decreases after revascularization in atherosclerotic renal artery disease a cohort study based on a multidisciplinary meeting |
| url | https://doi.org/10.1371/journal.pone.0218788 |
| work_keys_str_mv | AT florencesens bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT gabriellenormand bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT thomasfournier bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT nelliedellaschiava bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT stephaneluong bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT carolinepelletier bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT philiprobinson bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT sandrinelemoine bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT olivierrouviere bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting AT laurentjuillard bloodpressuredecreasesafterrevascularizationinatheroscleroticrenalarterydiseaseacohortstudybasedonamultidisciplinarymeeting |