Safak Erdal, Wilke Caroline, Derer Wolfgang, Busjahn Andreas, Gross Michael, Moeckel Martin, Mueller Dominik N, Luft Friedrich C, Dechend Ralf
Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany.
J Am Soc Hypertens. 2013 Jan-Feb;7(1):24-31. doi: 10.1016/j.jash.2012.12.001.
Atherosclerotic renal artery stenosis (ARAS) is a predictor of increased morbidity and mortality. However, whether ARAS itself accelerates the arteriosclerotic process or whether ARAS is solely the consequence of atherosclerosis is unclear. We imaged renal arteries of 1561 hypertensive patients undergoing coronary angiography and followed this cohort for 9 years (range, 2.4-15.1 years; median, 31.2 months, interquartile range, 13.4/52.9 months). All patients received aspirin, renin-angiotensin system blockade, statins, and beta blockade as indicated. One hundred seventy-one patients had ARAS >50% diameter stenosis and 126 patients an arteriosclerotic plaque (ARAP) without significant stenosis. Blood pressures were not different in ARAS, ARAP, and non-ARAS patients. After adjustment for cardiovascular risk factors by propensity scores and matched pair analysis, ARAS patients had a lower ejection fraction and more coronary artery disease (CAD) than non-ARAS patients. The same was true for brain natriuretic peptide values, troponin I, and highly sensitive C-reative protein. Over 9 years, more ARAS patients died of any cause (34% vs 23%; P < .05). The prevalence of CAD in ARAP patients was higher than in non-ARAS patients and lower than in ARAS patients. The mortality of the ARAP patients at 9 years was 37%, not different from the ARAS patients. Atherosclerotic renal artery disease appears to be a marker for the severity of atherosclerosis rather than a causative factor for atherosclerosis progression.
动脉粥样硬化性肾动脉狭窄（ARAS）是发病率和死亡率增加的一个预测因素。然而，ARAS本身是否会加速动脉硬化进程，或者ARAS仅仅是动脉粥样硬化的结果尚不清楚。我们对1561例接受冠状动脉造影的高血压患者的肾动脉进行了成像，并对该队列进行了9年的随访（范围为2.4 - 15.1年；中位数为31.2个月，四分位间距为13.4/52.9个月）。所有患者均根据指征接受阿司匹林、肾素 - 血管紧张素系统阻滞剂、他汀类药物和β受体阻滞剂治疗。171例患者的ARAS直径狭窄>50%，126例患者有动脉粥样硬化斑块（ARAP）但无明显狭窄。ARAS、ARAP和非ARAS患者的血压无差异。通过倾向评分和配对分析对心血管危险因素进行校正后，ARAS患者的射血分数低于非ARAS患者，冠状动脉疾病（CAD）更多。脑钠肽值、肌钙蛋白I和高敏C反应蛋白也是如此。在9年期间，更多的ARAS患者死于任何原因（34%对23%；P < 0.05）。ARAP患者中CAD的患病率高于非ARAS患者且低于ARAS患者。ARAP患者9年时的死亡率为37%，与ARAS患者无差异。动脉粥样硬化性肾动脉疾病似乎是动脉粥样硬化严重程度的一个标志物，而非动脉粥样硬化进展的一个致病因素。
