高血压伴动脉粥样硬化性肾动脉狭窄患者的肾功能保护性治疗随访观察OACSTPCD

Objective To explore the therapeutic strategy of renal function protection in hypertensive patients with atheroscle-rotic renal artery stenosis(ARAS).Methods A total of 77 hypertensive patients with unilateral or bilateral renal artery stenosis(≥30%)by renal arteriography from December 2019 to June 2022 were enrolled in this study.The patients were treated with optimal medical therapy(OMT)and"OMT+renal artery revascularization"(OMTR)and were followed up.Patients with unilateral ARAS were divided into four groups according to different degree of renal artery stenosis:mild stenosis group(30%-49%),moderate steno-sis group(50%-69%),severe stenosis group(70%-89%)and extremely severe stenosis group(≥90%).The split renal function(SRF)of the stenotic side and the contralateral side were compared and followed up.Results In OMT group(n=46),the types of antihypertensive drugs increased after 3 months of treatment(P<0.05),with an upward trend of the systolic and diastolic blood pres-sure.After drug adjustment and optimization,the systolic blood pressure decreased significantly at 12 months of follow-up compared with 3 months(P<0.05),and the serum creatinine(SCr)level did not increase significantly during the follow-up period.For 31 pa-tients receiving renal artery revascularization(RAR),the types of antihypertensive drugs and SCr levels increased at 6 months after op-eration(P<0.05),then the SCr levels decreased at 12 months of follow-up compared with 6 months after drug optimization(P<0.05),and blood pressure levels did not change significantly during follow-up.Compared with the OMT group,there was no signifi-cant difference in baseline blood pressure between the two groups,but the baseline SCr level of patients in the OMTR group was higher(P<0.05),and there was no significant difference in blood pressure,types of antihypertensive drugs and SCr level between the two groups at the end point of follow-up(12 months).For patients with unilateral ARAS(n=42),the glomerular filtration rate(GFR)in the affected side of kidney was significantly lower compared with the contralateral healthy kidney in the extremely severe stenosis group[(27.94±16.51)ml/min vs.(46.47±16.30)ml/min;P<0.05].Postoperative SRF test also showed that two patients with ex-tremely severe renal artery stenosis had an improvement in GFR on the affected side of kidney.Conclusions For hypertensive patients with ARAS,it is of great importance to closely follow up and continuously optimize the OMT strategy regardless of RAR treatment is carried out.Stable control of blood pressure is helpful to prevent the occurrence of hypertensive kidney damage.ARAS patients with extremely severe renal artery stenosis(≥90%)are at high risk for ischemic kidney disease and may benefit from RAR therapy.