Dec. 02--For people whose renal arteries are narrowing, taking medicine to
restore blood flow to the kidneys is a less risky and more cost-effective option
than undergoing a common procedure to insert stents, according to a new study
co-authored by Dr. William Henrich, president of the University of Texas Health
Henrich said he began work on the study in 1998, when he was the chairman of
medicine at what was then called the Medical College of Ohio. The National
Heart, Lung and Blood Institute funded the research, which was published Nov. 18
in the New England Journal of Medicine.
"The good news is that managing them with blood pressure medicine ... has a good
outcome in this population" without the risks and expense of surgery, he said.
Henrich said narrowing or hardening of the renal arteries is a process of aging
and common among those older than 65. It can be associated with high blood
pressure, high cholesterol or diabetes, he said.
However, treatment for similar patients varied widely in different parts of the
country, he said. In some areas, a majority of patients underwent a procedure
called an angioplasty to insert stents -- miniature tubular scaffolding to hold
open the pathway. In other areas, patients weren't receiving stents.
Between 1996 and 2000, the number of the stent procedures among Medicare
beneficiaries each year rose by 364 percent, according to the study.
The procedure costs several thousand dollars, and there's a risk that it may
break loose small pieces of cholesterol plaque on the inside of blood vessels
that could cause blood flow problems farther downstream, he said.
The study relied on data from 931 patients enrolled around the country and the
world who were followed for a median of about 3 1/2 years.
Henrich said the study found no difference in kidney function or the frequency
of heart attack, stroke or hospitalization for heart failure for patients who
received stents and medication versus those who received medical therapy alone.
Patients received several inexpensive drugs, including two blood-pressure
medicines, a diuretic and another that blocks the hormone system linked to high
blood pressure. Other medicines included a cholesterol-lowering drug and aspirin
to keep the blood vessels open, he said.
Henrich said family physicians are comfortable managing these drugs, which could
save the patient a trip to see a specialist.
An editorial about the study published in the same journal by Dr. John Bittl, an
interventional cardiologist at the Munroe Regional Medical Center in Florida,
reinforced the findings.
Bittl wrote that patients with moderately severe narrowing of the renal arteries
and either hypertension or chronic kidney disease "should receive medical
therapy to control blood pressure and prevent the progression" of the disease
"but should not be corralled into getting a renal-artery stent."
Henrich said that when a study like this comes out with a clear result, it's
"widely read, and many doctors who are familiar with these kinds of patients ...
will be able to advise patients that they do not need these stents placed."
Experts may also take the findings into account the next time they revise the
medical guidelines on stents, he said.
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