Are demographic caracteristics of hypertensive patients different with renal artery stenosis?

Atheromatous renal disease is more and more involved in end stage renal failure in polyatheromatous patients. The goal of this work was to study the demographic differences between hypertensive patients with renal artery stenosis (PAS) or without PAS. Method: Between November 1995 and July 1997, 49 hypertensive patients were included consecutively for a suspicion of RAS. Age, sex, hypertension history, tabagism, cardiovascular heredity, body mass index, diabetes history, hypercholesterolemia, kaliemia, serum creatinine. creatinine clearance, systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were studied. A renal echo-doppler and a renal TDM were performed in all patients. A renal arteriography was performed in 23 patients with a RAS suspicion after the two morphologic exams. The demographic characteristics of both clinical groups control (group 1) and patients with unilateral RAS (group 2), were compared. Statistics: Descriptive analysis, Wilcoxon test, Khi 2 test, spearman correlation (P<0.05). Results: Group 2 patients were significantly older than group 1 patients (p=0.008) with a mean age difference of 8 years. Creatinine clearance was lower in patients suffering from RAS with a mean difference of 23 mL/min between groups 1 and 2 (p=0.0007) but we also had to take into account the negative correlation existing between creatinine clearance and age (r=0.63; p=0.0001) when interpreting these results. The DBP was lower (p=0.03) and the PP higher (p=0.01) in group 2. The SBP was higher in group 2 but this result was not significant. Mean differences in SBP and PP between group 1 and group 2 were 6 mmHg and 15 mm Hg respectively. Smoking was more common in group 2 (p=0.04). The history of hypertension, cardiovascular heredity, sex ratio (MIF), body mass index and prevalence of diabete were comparable between the two clinical groups. Conclusion: Although there were demographic differences between the two clinical groups, no clinical or biological variable could be used alone to identify which patients suffered from renal stenosis, because the distribution of these variables did not differ significantly between the two groups and the effective was small. Then, we thought that Krijnen's predictive rule is interesting in the screening of hypertensive patients with RAS suspicion.