摘要:

ObjectiveDifferent radiologists may show considerable variation in their interpretation of renal angiograms. We therefore wished to establish the reliability of their interpretation.DesignAssessment of the intra- and inter-observer agreement of the interpretation of renal angiograms.SettingTertiary referral university hospital.PatientsHypertensive patients suspected of renovascular hypertension on clinical grounds or on the basis of renography.InterventionsPatients were prospectively selected to undergo a renal angiography via the femoral approach.Main outcome measuresIntra- and inter-observer agreement of the degree and site of stenosis.ResultsThe difference between two estimates of the degree of stenosis ranged from 0 to 65% for the individual readers and from 0 to 75% between two readers. When the site of greatest stenosis was in the origin of the renal artery, the intra-observer agreement κ ranged from 0.54–0.71, the inter-observer agreement across multiple readers being 0.43. In apost hocanalysis using two different cutoff points of stenosis (50 or 70%), the intra- and inter-observer agreement was better at the 70% cut-off-point. In a subset of patients with stenosis and a renin ratio greater than 1.5, both the intra- and inter-observer agreement were much better than when all angiograms were considered.ConclusionsAssessment of the diagnostic performance of three experienced radiologists in their interpretation of renal artery angiograms indicates that the intra- and inter- observer agreement with respect to their estimates of the degree of stenosis and the site of greatest stenosis are rather poor but their diagnostic performance improves in patients with stenosis and a renin ratio greater than 1.5. There is a need for more objective assessment of renal artery lesions.

ISSN:0263-6352    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundPrevious studies in hypertensive patients with renovascular disease have shown both elevated sympathetic nerve activity and increased cardiovascular mortality.ObjectiveThe aim of the present study was to assess long-term survival in hypertensive patients with renal artery stenosis in relation to sympathetic activation, renal function and treatment regimens.Subjects and methodsA total of 169 consecutive patients aged 54 ± 1 years with hypertension underwent a clinical investigation for renovascular hypertension including renal angiography and measurement of bilateral renal renin secretion. In 107 of these patients, arterial plasma concentrations of noradrenaline were measured. The mean follow-up time was 7.1 ± 0.3 years and survival data were available in all patients up to May 1997. For comparison, healthy age-matched normotensive controls were examined.ResultsArterial noradrenaline concentrations were threefold elevated in hypertensive patients with renal artery stenosis compared to healthy controls (P< 0.01). During the follow-up time, 44 patients died. Cardiovascular mortality accounted for 75% of all deaths. The risk ratio for overall mortality in hypertensive patients with renal artery stenosis compared to the normal population of Sweden, matched for age, was 3.3 (2.4–4.4), whereas the risk ratio for cardiovascular mortality was 5.7 (3.9–8.0). The arterial plasma concentration of noradrenaline was 3:11 ± 0:30 pmol/ml in patients who died compared to 3:84 ± 0:26 pmol/ml in survivors. Reduced renal function and age were independent predictors of death. Survival did not differ between patients undergoing intervention with either renal angioplasty or surgical reconstruction for renal artery stenosis and patients not undergoing intervention.ConclusionsAlthough sympathetic nerve activity is elevated in hypertensive patients with renal artery stenosis, our results do not suggest that this adrenergic over-activity is directly linked to the observed high cardiovascular mortality. Mortality in hypertensive patients with renovascular disease remains high whether an interventional treatment is performed or not, possibly due to the concomitant coronary disease.

ISSN:0263-6352    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveArterial hypertension is an established risk factor for left ventricular hypertrophy (LVH) in the uremic population. However, whether 24-h monitoring is a better predictor of LVH than clinic blood pressure and routine pre-dialysis measurements in these patients is still undefined.MethodsThis problem was studied in 64 nondiabetic hemodialysis patients without heart failure. The echocardiographic study as well as the clinic and 24-h ambulatory blood pressure (BP) measurements were performed during the day off-dialysis. Pre-dialysis arterial pressure was calculated as the average value of the 12 routine recordings taken during the month preceding the study.ResultsIn multivariate models, including also sex, body mass index, hematocrit and serum cholesterol, pre-dialysis systolic, diastolic and pulse pressures were the only independent BP determinants of heart geometry. Twentyfour hour ambulatory BP monitoring (ABPM) did add significant (but weak) information to the prediction of left ventricular internal dimension, i.e. it increased by 9%(P= 0.01) the variance already explained by pre-dialysis diastolic BP and other significant covariates. However, 24h ABPM did not add any significant and independent explanatory information to the corresponding pre-dialysis measurements for the posterior wall and interventricular septum measurements, and for left ventricular mass (−0.6 to +3.9%; average +1.1%).ConclusionsIn dialysis patients, pre-dialysis BP is at least as strong a predictor of left ventricular mass as 24-h ambulatory monitoring. Thus, the average of 12 routine pre-dialysis measurements may be used to predict heart geometry in dialysis patients without any loss of information in comparison with 24-h ambulatory monitoring.

ISSN:0263-6352    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThis study compares the effects of an AT1angiotensin II receptor antagonist (valsartan) with those of an ACE inhibitor (enalapril) on left ventricular (LV) diastolic function in patients with mild or moderate essential hypertension and no evidence of LV hypertrophy at echocardiography.MethodsA total of 24 patients (16 men, mean age 47 ± 8 years) underwent radionuclide ambulatory monitoring (Vest) of LV function at rest and during upright bicycle exercise testing before and after two 4-week treatment periods with valsartan (80–160 mg/day orally) and enalapril (20–40 mg/day orally) according to a double-blind, crossover randomization scheme.ResultsIn the overall population no differences between the two treatments were found in LV peak filling rate (PFR) either at rest or at peak exercise. In a subgroup analysis it was found that baseline PFR was normal (= 2.5 EDV/sec) in 12 patients (subgroup A) and impaired (< 2.5 EDV/sec) in the remaining 12 (subgroup B). In both subgroups, valsartan and enalapril induced a significant and comparable reduction of systolic and diastolic blood pressure. In subgroup A, valsartan and enalapril did not induce significant changes in PFR. In subgroup B, valsartan increased PFR both at rest (from 2.0 ± 0.3 to 2.4 ± 0.3 EDV/sec,P< 0.01) and at peak exercise (from 4.1 ± 1.1 to 4.4 ± 1.0 EDV/s,P< 0.05), whereas enalapril did not change PFR either at rest (2.06 0.4 EDV/s,P< 0.01 versus valsartan) or at peak exercise (3.7 ± 1.1 EDV/sec,P< 0.05 versus valsartan).ConclusionsValsartan-induced renin-angiotensin system blockade is able to improve LV filling in patients with mild or moderate essential hypertension and impaired diastolic function. These findings support the hypothesis of a contribution of the renin–angiotensin system in the control of LV diastolic function in these patients.

ISSN:0263-6352    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the effect of an extended-release nitrate preparation on the arterial pulse wave and blood pressure of patients in whom systolic blood pressure was elevated in part by exaggerated pulse-wave reflectance.DesignA double-blind randomized placebo-controlled crossover study was carried out.Patients and methodsThe subjects were ten elderly patients with systolic hypertension resistant to conventional anti-hypertensive therapy. Pharmacodynamic responses to 2-week courses of placebo/isosorbide mononitrate (ISMN) were assessed in seven subjects by an ambulatory blood pressure monitor, and in all ten subjects by standard sphygmomanometry, arterial pulse- wave analysis and measurement of plasma nitrate concentration during peak and trough.ResultsAmbulatory systolic blood pressure was decreased by ISMN (P< 0.02) between 1000 and 2200 h. Ambulatory diastolic blood pressure fell with ISMN(P< 0.01) during the last 4 h of this period. At peak plasma nitrate levels, ISMN decreased the aortic systolic blood pressure (P< 0.01), ejection peak (P< 0.02) and augmentation component (P< 0.001) of the pulse wave; heart rate increased slightly (P< 0.03).ConclusionISMN has a role as an adjunct in the anti-hypertensive therapy of patients with refractory systolic hypertension due to exaggerated pulse-wave reflectance.

ISSN:0263-6352    

出版商:OVID    

年代:1999

数据来源: OVID