A Cochrane review [Abstract] 1 included 8 studies with a total of 2 222 patients. Included studies compared primary balloon angioplasty (with or without insertion of a stent) and medical therapy in adults with hypertension and uni- or bilateral atherosclerotic renal artery stenosis (stenosis greater than 50%). A small improvement in diastolic blood pressure (DBP), no significant improvement in systolic blood pressure (SBP), a small decrease in the mean number of antihypertensive drugs, and no significant effect on renal function as measured by serum creatinine were found between balloon angioplasty and medical therapy groups. There were no differences in cardiovascular or renal adverse events between groups. A small number of procedural complications of balloon angioplasty were reported (haematoma at the site of catheter insertion (6.5%), femoral artery pseudoaneurysm (0.7%), renal artery or kidney perforation or dissection (2.5%) as well as peri-procedural deaths (0.4%)). No side effects of medical therapy were reported.
None of the studies presented data separately according to the severity of the renal artery stenosis, and only one study analysed results separately for participants with unilateral and bilateral stenosis. It was not possible to carry out subgroup analyses to identify groups of patients who may potentially have a greater clinical benefit from angioplasty.
| Outcome | Participants (studies) | Effect size (95% CI) |
|---|---|---|
| *at 2 years or end of follow-up | ||
| Change in SBP* | 1 743 (5 studies) | MD -1.07 mmHg (-3.45 to 1.30) |
| Change in DBP* | 809 (4 studies) | MD -2.00 mmHg (-3.72 to -0.27) |
| Serum creatinine* | 725 (3 studies) | MD -7.99 µmol/L (-22.60 to 6.62) |
| Number of antihypertensive drugs | 1 717 (3 studies) | MD -0.18 (-0.34 to -0.03) |
| Cardiovascular adverse events | 2 110 (7 studies) | Peto OR 0.91 (0.75 to 1.11) |
| Renal adverse events | 2 104 (7 studies) | Peto OR 1.02 (0.75 to 1.38) |
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of/unclear blinding), by inconsistency (variablity in results), and by imprecise results (few patients and wide confidence intervals).
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