Use of B-Type Natriuretic Peptide to Predict Blood Pressure Improvement after Percutaneous Revascularisation for Renal Artery Stenosis

Staub, D.; Zeller, T.; Trenk, D.; Maushart, C.; Uthoff, H.; Breidthardt, T.; Klima, T.; Aschwanden, M.; Socrates, T.; Arenja, N.; Twerenbold, R.; Rastan, A.; Sixt, S.; Jacob, A.L.; Jaeger, K.A.; Mueller, C.

doi:10.1016/j.ejvs.2010.07.013

« Previous Next »European Journal of Vascular & Endovascular Surgery
Volume 40, Issue 5 , Pages 599-607, November 2010

Use of B-Type Natriuretic Peptide to Predict Blood Pressure Improvement after Percutaneous Revascularisation for Renal Artery Stenosis

D. Staub
- Department of Angiology, University Hospital Basel, Basel, Switzerland
- First two authors contributed equally to this work.
T. Zeller
- Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
- First two authors contributed equally to this work.
D. Trenk
- Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
C. Maushart
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
H. Uthoff
- Department of Angiology, University Hospital Basel, Basel, Switzerland
T. Breidthardt
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
T. Klima
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
M. Aschwanden
- Department of Angiology, University Hospital Basel, Basel, Switzerland
T. Socrates
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
N. Arenja
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
R. Twerenbold
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
A. Rastan
- Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
S. Sixt
- Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
A.L. Jacob
- Division of Interventional Radiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
K.A. Jaeger
- Department of Angiology, University Hospital Basel, Basel, Switzerland
C. Mueller
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
- Corresponding author. Tel.: +41 61 265 58 26; fax: +41 61 265 5353.

Received 7 May 2010; accepted 19 July 2010. published online 26 August 2010.

Abstract

Objectives

The purpose of this study was to evaluate the utility of B-type natriuretic peptide (BNP) to predict blood pressure (BP) response in patients with renal artery stenosis (RAS) after renal angioplasty and stenting (PTRA).

Methods

In 120 patients with RAS and hypertension referred for PTRA, 24-h ambulatory BP recordings were obtained before and 6 months after intervention. BNP was measured before, 1 day and 6 months after PTRA.

Results

BP improved in 54% of patients. Median BNP levels pre-intervention were 97 pg ml⁻¹ (interquartile range (IQR) 35–250) and decreased significantly within 1 day of PTRA to 62 pg ml⁻¹ (IQR 24–182) (p < 0.001), remaining at 75 pg ml⁻¹ (IQR 31–190) at 6 months. The area under the receiver operating curve for pre-intervention BNP to predict BP improvement was 0.57 (95% confidence interval (CI) 0.46–0.67). Pre-intervention BNP >50 pg ml⁻¹ was seen in 79% of patients with BP improvement compared with 56% in patients without improvement (p = 0.01). In a multivariate logistic regression analysis, BNP >50 pg ml⁻¹ was significantly associated with BP improvement (odds ratio (OR) 4.0, 95% CI 1.2–13.2).

Conclusions

BNP levels are elevated in patients with RAS and decrease after revascularisation. Although BNP does not seem useful as a continuous variable, pre-interventional BNP >50 pg ml⁻¹ may be helpful to identify patients in whom PTRA will improve BP.

Keywords: Natriuretic peptides, Renal artery stenosis, Renal hypertension, Angioplasty