Resistance to antihypertensive medication as predictor of renal artery stenosis: Comparison of two drug regimens

B. C. Van Jaarsveld, P. Krijnen, F. H.M. Derkx, J. Deinum, A. J.J. Woittiez, C. T. Postma, M. A.D.H. Schalekamp

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Renal artery stenosis is among the most common curable causes of hypertension. The definitive diagnosis is made by renal angiography, an invasive and costly procedure. The prevalence of renal artery stenosis is less than 1% in non-selected hypertensive patients but is higher when hypertension is resistant to drugs. Objective: To study the usefulness of standardised two-drug regimens for identifying drug-resistant hypertension as a predictor of renal artery stenosis. Design and setting: Prospective cohort study carried out in 26 hospitals in The Netherlands. Patients: Patients had been referred for analysis of possible secondary hypertension or because hypertension was difficult to treat. Patients ≤40 years of age were assigned to either amlodipine 10 mg or enalapril 20 mg, and patients >40 years to either amlodipine 10 mg combined with atenolol 50 mg or to enalapril 20 mg combined with hydrochlorothiazide 25 mg. Renal angiography was performed: (1) if hypertension was drug-resistant, ie if diastolic pressure remained ≥95 mm Hg at three visits 1-3 weeks apart or an extra drug was required, and/or (2) if serum creatinine rose by ≥20 μmol/L (≥0.23 mg/dL) during ACE inhibitor treatment. Results: Of the 1106 patients with complete follow-up, 1022 had been assigned to either the amlodipine- or enalapril-based regimens, 772 by randomisation. Drug-resistant hypertension, as defined above, was identified in 41% of the patients, and 20% of these had renal artery stenosis. Renal function impairment was observed in 8% of the patients on ACE inhibitor, and this was associated with a 46% prevalence of renal artery stenosis. In the randomised patients, the prevalence of renal artery stenosis did not differ between the amlodipine- and enalapril-based regimens. Conclusions: In the diagnostic work-up for renovascular hypertension the use of standardised medication regimens of maximally two drugs, to identify patients with drug-resistant hypertension, is a rational first step to increase the a priori chance of renal artery stenosis. Amlodipine- or enalapril-based regimens are equally effective for this purpose.

Original languageEnglish
Pages (from-to)669-676
Number of pages8
JournalJournal of Human Hypertension
Volume15
Issue number10
DOIs
Publication statusPublished - 29 Oct 2001

Cite this

Van Jaarsveld, B. C. ; Krijnen, P. ; Derkx, F. H.M. ; Deinum, J. ; Woittiez, A. J.J. ; Postma, C. T. ; Schalekamp, M. A.D.H. / Resistance to antihypertensive medication as predictor of renal artery stenosis : Comparison of two drug regimens. In: Journal of Human Hypertension. 2001 ; Vol. 15, No. 10. pp. 669-676.
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title = "Resistance to antihypertensive medication as predictor of renal artery stenosis: Comparison of two drug regimens",
abstract = "Background: Renal artery stenosis is among the most common curable causes of hypertension. The definitive diagnosis is made by renal angiography, an invasive and costly procedure. The prevalence of renal artery stenosis is less than 1{\%} in non-selected hypertensive patients but is higher when hypertension is resistant to drugs. Objective: To study the usefulness of standardised two-drug regimens for identifying drug-resistant hypertension as a predictor of renal artery stenosis. Design and setting: Prospective cohort study carried out in 26 hospitals in The Netherlands. Patients: Patients had been referred for analysis of possible secondary hypertension or because hypertension was difficult to treat. Patients ≤40 years of age were assigned to either amlodipine 10 mg or enalapril 20 mg, and patients >40 years to either amlodipine 10 mg combined with atenolol 50 mg or to enalapril 20 mg combined with hydrochlorothiazide 25 mg. Renal angiography was performed: (1) if hypertension was drug-resistant, ie if diastolic pressure remained ≥95 mm Hg at three visits 1-3 weeks apart or an extra drug was required, and/or (2) if serum creatinine rose by ≥20 μmol/L (≥0.23 mg/dL) during ACE inhibitor treatment. Results: Of the 1106 patients with complete follow-up, 1022 had been assigned to either the amlodipine- or enalapril-based regimens, 772 by randomisation. Drug-resistant hypertension, as defined above, was identified in 41{\%} of the patients, and 20{\%} of these had renal artery stenosis. Renal function impairment was observed in 8{\%} of the patients on ACE inhibitor, and this was associated with a 46{\%} prevalence of renal artery stenosis. In the randomised patients, the prevalence of renal artery stenosis did not differ between the amlodipine- and enalapril-based regimens. Conclusions: In the diagnostic work-up for renovascular hypertension the use of standardised medication regimens of maximally two drugs, to identify patients with drug-resistant hypertension, is a rational first step to increase the a priori chance of renal artery stenosis. Amlodipine- or enalapril-based regimens are equally effective for this purpose.",
keywords = "Diagnostic test, Drug-resistance, Renal artery stenosis, Renovascular hypertension",
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Resistance to antihypertensive medication as predictor of renal artery stenosis : Comparison of two drug regimens. / Van Jaarsveld, B. C.; Krijnen, P.; Derkx, F. H.M.; Deinum, J.; Woittiez, A. J.J.; Postma, C. T.; Schalekamp, M. A.D.H.

In: Journal of Human Hypertension, Vol. 15, No. 10, 29.10.2001, p. 669-676.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Resistance to antihypertensive medication as predictor of renal artery stenosis

T2 - Comparison of two drug regimens

AU - Van Jaarsveld, B. C.

AU - Krijnen, P.

AU - Derkx, F. H.M.

AU - Deinum, J.

AU - Woittiez, A. J.J.

AU - Postma, C. T.

AU - Schalekamp, M. A.D.H.

PY - 2001/10/29

Y1 - 2001/10/29

N2 - Background: Renal artery stenosis is among the most common curable causes of hypertension. The definitive diagnosis is made by renal angiography, an invasive and costly procedure. The prevalence of renal artery stenosis is less than 1% in non-selected hypertensive patients but is higher when hypertension is resistant to drugs. Objective: To study the usefulness of standardised two-drug regimens for identifying drug-resistant hypertension as a predictor of renal artery stenosis. Design and setting: Prospective cohort study carried out in 26 hospitals in The Netherlands. Patients: Patients had been referred for analysis of possible secondary hypertension or because hypertension was difficult to treat. Patients ≤40 years of age were assigned to either amlodipine 10 mg or enalapril 20 mg, and patients >40 years to either amlodipine 10 mg combined with atenolol 50 mg or to enalapril 20 mg combined with hydrochlorothiazide 25 mg. Renal angiography was performed: (1) if hypertension was drug-resistant, ie if diastolic pressure remained ≥95 mm Hg at three visits 1-3 weeks apart or an extra drug was required, and/or (2) if serum creatinine rose by ≥20 μmol/L (≥0.23 mg/dL) during ACE inhibitor treatment. Results: Of the 1106 patients with complete follow-up, 1022 had been assigned to either the amlodipine- or enalapril-based regimens, 772 by randomisation. Drug-resistant hypertension, as defined above, was identified in 41% of the patients, and 20% of these had renal artery stenosis. Renal function impairment was observed in 8% of the patients on ACE inhibitor, and this was associated with a 46% prevalence of renal artery stenosis. In the randomised patients, the prevalence of renal artery stenosis did not differ between the amlodipine- and enalapril-based regimens. Conclusions: In the diagnostic work-up for renovascular hypertension the use of standardised medication regimens of maximally two drugs, to identify patients with drug-resistant hypertension, is a rational first step to increase the a priori chance of renal artery stenosis. Amlodipine- or enalapril-based regimens are equally effective for this purpose.

AB - Background: Renal artery stenosis is among the most common curable causes of hypertension. The definitive diagnosis is made by renal angiography, an invasive and costly procedure. The prevalence of renal artery stenosis is less than 1% in non-selected hypertensive patients but is higher when hypertension is resistant to drugs. Objective: To study the usefulness of standardised two-drug regimens for identifying drug-resistant hypertension as a predictor of renal artery stenosis. Design and setting: Prospective cohort study carried out in 26 hospitals in The Netherlands. Patients: Patients had been referred for analysis of possible secondary hypertension or because hypertension was difficult to treat. Patients ≤40 years of age were assigned to either amlodipine 10 mg or enalapril 20 mg, and patients >40 years to either amlodipine 10 mg combined with atenolol 50 mg or to enalapril 20 mg combined with hydrochlorothiazide 25 mg. Renal angiography was performed: (1) if hypertension was drug-resistant, ie if diastolic pressure remained ≥95 mm Hg at three visits 1-3 weeks apart or an extra drug was required, and/or (2) if serum creatinine rose by ≥20 μmol/L (≥0.23 mg/dL) during ACE inhibitor treatment. Results: Of the 1106 patients with complete follow-up, 1022 had been assigned to either the amlodipine- or enalapril-based regimens, 772 by randomisation. Drug-resistant hypertension, as defined above, was identified in 41% of the patients, and 20% of these had renal artery stenosis. Renal function impairment was observed in 8% of the patients on ACE inhibitor, and this was associated with a 46% prevalence of renal artery stenosis. In the randomised patients, the prevalence of renal artery stenosis did not differ between the amlodipine- and enalapril-based regimens. Conclusions: In the diagnostic work-up for renovascular hypertension the use of standardised medication regimens of maximally two drugs, to identify patients with drug-resistant hypertension, is a rational first step to increase the a priori chance of renal artery stenosis. Amlodipine- or enalapril-based regimens are equally effective for this purpose.

KW - Diagnostic test

KW - Drug-resistance

KW - Renal artery stenosis

KW - Renovascular hypertension

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