In their study published in the April issue of Mayo Clinic Proceedings, researchers found a significant prevalence (19 percent) of renal artery narrowing among hypertensive patients undergoing coronary catheterization. They suggest that abdominal aortography should be considered in these patients to better define their risk of cardiovascular complications.
Charanjit S. Rihal, M.D., a Mayo Clinic cardiologist and principal author of the study, said the results are the first step in the research. Determining the best treatment for the artery blockages is the next step.
"We recommend considering screening abdominal aortography in hypertensive patients undergoing diagnostic coronary angiography to better define cardiovascular risk for the individual patient. Patients with renal artery stenosis deserve close follow up with attention to their blood pressure and kidney function. As of yet we do not recommend routine angioplasty," Dr. Rihal said.
Systemic hypertension is the most commonly recorded cardiovascular abnormality that affects more than 65 million people in the United States, including more than 50 percent of patients older than age 60 years.
In the study of 297 patients, 53 percent of the patients had normal renal arteries. They found 28 percent had stenoses less than 50 percent, while 19.2 percent had stenoses of 50 percent or more. Patients with renal artery stenosis were more likely to have had a previous coronary intervention.
Other authors contributing to the study were Stephen C. Textor, M.D., Jerome F. Breen, M.D., Michael McKusick, M.D., Diane E. Grill, M.S., David R. Holmes, M.D., all of Mayo Clinic, and John W. Hallett, M.D., who is now with the Eastern Maine Medical Center.
R. Eugene Zierler, M.D., of the Department of Surgery at the University of Washington School of Medicine, writes in the Mayo Clinic Proceedings editorial that the main value of this study is the data provided on the prevalence and severity of renal artery disease in this selected patient population. Dr. Zierler concurs with the researchers that further study is needed.
"The recommendation that screening renal arteriography be considered in patients undergoing coronary angiography may be difficult to justify based on strict clinical or epidemiologic grounds," says Dr. Zierler.
Mayo Clinic Proceedings is a peer-reviewed and indexed general internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 130,000 nationally and internationally.
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