[Efficacy of monotherapy with 15 antihypertensive agents in treating essential hypertension assessed by 24-hour ambulatory blood pressure monitoring].

OBJECTIVE: To evaluate the efficacy of the monotherapy of 15 agents in treating essential hypertension. METHODS: After 2-week wash-out, a total of 370 patients with seated diastolic blood pressure 95-114 mmHg and seated systolic blood pressure < 180 mmHg were randomized to different therapeutic groups. 24-hour ambulatory blood pressure monitoring was performed before medication and at the end of 8 weeks. RESULT: All the agents significantly reduced the 24 hour mean blood pressures after treatment except doxazosin, terazosin, and torasemide. CONCLUSION: The result suggested that the angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers and long-acting calcium antagonists were effective in treating essential hypertension, while the low-dose doxazosin, terazosin and torasemide can be used for combination therapy but not for monotherapy.

[Effects of renal artery stenting on renal function of patients with ischaemic nephropathy].

OBJECTIVES: To evaluate the effects of stent revascularization on renal function of patients with atherosclerotic renal artery stenosis with renal insufficiency. METHODS: Percutaneous transluminal renal angioplasty with stent (PTRAS) was performed on 27 consecutive patients with severe atherosclerotic renal artery stenosis for preservation of renal function, and follow-up was conducted for 6 approximately 48 months. RESULTS: Technically PTRAS was successfully performed in all 27 patients. The creatinine value was 155 micromol/L +/- 31 micromol/L before operation, and increased to 189 micromol/L +/- 38 micromol/L (P < 0.001), then decreased to 145 micrommol/L +/- 22 micrommol/L, 143 micromol/L +/- 22 micromol/L, 143 micromol/L +/- 24 micromol/L, and 139 micromol/L +/- 10 micromol/L, 6, 12, 24, and 36 months after the PTRAS respectively (all P < 0.05). The severe complications related to the procedure mainly included 7 cases of acute renal failure, 4 cases being reversible. One case died of cardiac infarction with underlying coronary heart disease 9 months after and 1 case died heart failure due to valvular disease of heart 25 months after. CONCLUSION: Renal artery stent revascularization is effective for preservation of renal function in patients with ischaemic nephropathy effect on. However, complications related to the procedure frequently occurred. The long-term efficacy is to be investigated further.

[Clinical results of stent revascularization as treatment for renal artery stenosis during 6 months of follow-up].

OBJECTIVES: To evaluate the safety and midterm efficacy of stent revascularization as treatment for renal artery stenosis. METHODS: Percutaneous transluminal renal angioplasty with stent (PTRA) was performed because of poorly controlled hypertension or preservation of renal function in 150 consecutive patients with severe renal artery stenosis, caused by atheroma (96 patients), arteritis (44 patients) and fibromuscular dysplasia (10 patients). All of them subsequently underwent 6-month clinical follow-up to observe the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications. RESULT: Angiographic success was obtained in 148 (98.7%) of 150 patients after PTRA. At 6 months, both systolic and diastolic blood pressures significantly decreased (from 169.6 to 142.7 mm Hg and from 97.3 to 83.3 mm Hg, respectively; P < 0.001), and less antihypertensive medication was taken (from 2.7 to 1.9). The blood pressure became normal without taking any antihypertensive medications in 48 of 150 patients (32.0%), and the blood pressure control was more facile in 78 patients (52.0%), however, there were no improvement in 22 patients (16.0%). Creatinine level decreased in 34 patients (22.7%), remained stable in 112 patients (74.6%), and increased in 4 (2.7%). There was no statistical significance. No deaths occurred during 6-months follow-up. CONCLUSIONS: Renal artery stent revascularization had a beneficial effect on blood pressure control and a nondeleterious effect on renal function during 6-months follow-up. The long-term efficacy should be investigated. The procedure is safe in usual.