P-153: Reduced survival in atherosclerotic renovascular hypertensives compared to age, gender, and race-matched essential hypertensives

Survival in renovascular hypertension (RVH) that has been successfully treated with angioplasty and/or surgery has not been carefully studied. We compared all-cause mortality in 58 consecutive patients with atherosclerotic RVH diagnosed from 1987–92 (see Arch Int Med, 1993; :755–764) with 174 controls with essential hypertension (EH). The atherosclerotic RVH patients were successfully revascularized with angioplasty and/or surgery. These EH control patients were matched (3:1) for age (64.2 ± 1.5 vs 64.2 ± 0.8 years, mean ± standard deviation, P = 0.99), gender (29% vs. 29% men, P = 0.99), race/ethnicity (50% vs. 50% white, P = 0.99), and date of initial visit (24 SEP 89 ± 82 days vs. 25 JAN 89 ± 74 days, P = 0.21). All patients with EH had a low probability of RVH, based on clinical grounds. RVH patients had higher initial blood pressures (BP) compared to the EH patients (systolic BP 213 ± 4 vs. 175 ± 2 mm Hg, P < 0.0001; diastolic BP 111 ± 2 vs. 98 ± 1, P < 0.0001). Following Institutional Review Board approval, follow-up information was gathered by mail, telephone, and/or query of the Social Security Death Index through November 30, 2001. Comparisons were made using t-tests, chi-square, and log-rank tests. Cox proportional hazards regression was used in survival analyses to adjust for baseline differences between the groups. During an average of 12.5 years of possible follow-up, 28 of the 58 (48.3%) RVH patients died compared with 43 of 174 (24.7%) EH patients. The unadjusted risk ratio showed a 1.95-fold increase in all-cause mortality (95% confidence interval 1.35–2.83, P < 0.01) in RVH patients compared to EH patients. After adjustment for baseline systolic blood pressure, RVH was associated with a 1.96-fold increase in mortality (95% confidence interval 1.06–3.63, P < 0.01) compared to EH patients. These data suggest that, despite successful revascularization, RVH patients still have an increased mortality compared to EH patients. Am J Hypertens (2004) 17, 89A–90A; doi: 10.1016/j.amjhyper.2004.03.228