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Incidental Renal Artery Stenosis Among a Prospective Cohort of Hypertensive Patients Undergoing Coronary Angiography

      Objective

      To determine the feasibility, safety, and clinical yield of angiographic screening among hypertensive patients undergoing coronary angiography.

      Patients and Methods

      This study was a prospective cohort analysis of hypertensive patients who underwent cardiac catheterization at a tertiary care referral center from July 1998 to March 1999. Abdominal aortography was performed to screen for renal artery stenosis, the percentage of which was measured.

      Results

      The mean SD age of the 297 study patients was 64.910.2 years; 58.6% were male, and 98.0% were white. Mean SD systolic/diastolic blood pressure was 142.822.5/79.611.4 mm Hg. Aortography required a mean incremental dose of 629 mL of nonionic contrast agent. No complications were attributable to aortography. Of 680 renal arteries, 611 (90%) were visualized adequately. Also, 53% of patients had normal renal arteries, 28% had stenoses less than 50%, and 19.2% had stenoses of 50% or more. Renal artery stenosis was bilateral in 3.7% of patients and high grade (>70% stenosis) in 7% Patients with renal artery stenosis were more likely to have had a previous coronary intervention. in multivariate analysis, systolic blood pressure (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.03-1.38; P=.02), history of stroke or transient ischemic attack (OR, 2.7; 95% CI, 1.27-5.78; P=.01), and cancer (OR, 2.0; 95% CI, 1.02-3.82; P=.04) independently correlated with renal artery stenosis of 50% or more.

      Conclusion

      The prevalence of incidental renal artery stenosis among hypertensive patients undergoing coronary catheterization is significant. Therefore, screening abdominal aortography should be considered in these patients to better define their risk of cardiovascular complications.
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