Usefulness of Wide Pulse Pressure as a Predictor of Poor Outcome After Renal Artery Angioplasty and Stenting

Renal artery stenosis is a common cause of secondary hypertension and ischemic nephropathy. Percutaneous angioplasty and stent placement has allowed select patients with renal artery stenosis to use fewer antihypertensive agents and improve or stabilize renal function. The associations of baseline systolic, diastolic, and pulse pressures (PPs) with outcomes of blood pressure (BP) and renal function were examined in 243 patients who underwent renal angioplasty and stent placement. The average PP before the procedure in patients with improvements or stabilizations in renal function was 53 ± 20 mm Hg, compared to 107 ± 18 mm Hg (p <0.05) in those with poorer outcomes. The average PPs before procedure were 47 ± 15 mm Hg in those with improvements in BP, 82 ± 10 mm Hg in those with stabilizations of BP, and 111 ± 14 mm Hg in those with worsening BP. All findings were statistically significant (p <0.05). In conclusion, wide PP may reflect more advanced vascular stiffness and renal disease distinguishing patients less likely to benefit from revascularization.