Combination of medical therapy and percutaneous transluminal renal angioplasty versus medical therapy alone for patients with atherosclerotic renal artery stenosis: systematic review and meta-analysis.

IF 4.3 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Takeshi Fujiwara, Yoshio Iwashima, Keisuke Narita, Michihiro Satoh, Atsushi Sakima
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Abstract

We investigated whether the combination of medical therapy plus percutaneous transluminal renal angioplasty (PTRA) provides superior clinical outcomes compared to those afforded by medical therapy alone in patients with hypertension due to atherosclerotic renal artery stenosis (ARAS) by conducting a systematic review and meta-analysis of the relevant randomized controlled trials (RCTs). The evaluated outcomes included: (1) cardiovascular disease (CVD)-related mortality, (2) the incidence of CVD events, (3) changes in blood pressure (BP), (4) suppression of renal function decline, (5) changes in the number of antihypertensive drugs used, and (6) serious adverse events. Nine RCTs involving 2275 patients were analyzed, revealing that the combination therapy significantly reduced the number of antihypertensive drugs compared to medical therapy alone (mean difference: -0.42, 95% confidence interval: -0.71 to -0.12). However, there were no significant differences between the combination therapy and medical therapy alone in CVD mortality, the incidence of CVD events, BP changes, suppression of renal function decline, or serious adverse events. The included studies demonstrated a low-to-moderate risk of bias, with performance and detection bias being the most prominent concerns. Together our findings demonstrate that compared to medical therapy alone, the combination of medical therapy + PTRA reduced the number of antihypertensive drugs used but did not improve adverse CVD or renal outcomes. The quality of the included RCTs represents a potential limitation of this analysis.

药物治疗联合经皮腔内肾血管成形术对动脉粥样硬化性肾动脉狭窄患者的治疗效果:系统评价和荟萃分析
我们通过对相关随机对照试验(RCTs)进行系统回顾和荟萃分析,研究药物治疗联合经皮腔内肾血管成形术(PTRA)是否比单独药物治疗对动脉粥样硬化性肾动脉狭窄(ARAS)高血压患者有更好的临床效果。评估结果包括:(1)心血管疾病(CVD)相关死亡率,(2)CVD事件发生率,(3)血压(BP)变化,(4)抑制肾功能下降,(5)降压药使用数量变化,(6)严重不良事件。我们分析了9项随机对照试验,共2275例患者,结果显示联合治疗与单独药物治疗相比显著减少了降压药物的数量(平均差值:-0.42,95%可信区间:-0.71 ~ -0.12)。然而,联合治疗与单独药物治疗在CVD死亡率、CVD事件发生率、血压变化、抑制肾功能下降、严重不良事件方面无显著差异。纳入的研究显示低至中等偏倚风险,表现和检测偏倚是最突出的问题。总之,我们的研究结果表明,与单独药物治疗相比,药物治疗+ PTRA联合治疗减少了降压药物的使用数量,但没有改善不良的心血管疾病或肾脏结局。纳入的随机对照试验的质量代表了本分析的潜在局限性。
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来源期刊
Hypertension Research
Hypertension Research 医学-外周血管病
CiteScore
7.40
自引率
16.70%
发文量
249
审稿时长
3-8 weeks
期刊介绍: Hypertension Research is the official publication of the Japanese Society of Hypertension. The journal publishes papers reporting original clinical and experimental research that contribute to the advancement of knowledge in the field of hypertension and related cardiovascular diseases. The journal publishes Review Articles, Articles, Correspondence and Comments.
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