Angioplastia con balón, con y sin stent, versus tratamiento médico para pacientes con hipertensión y estenosis de la arteria renal
Información
- DOI:
- https://doi.org/10.1002/14651858.CD002944.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 05 diciembre 2014see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Vascular
- Copyright:
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- Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Dr Sara Jenks selected trials for inclusion in the review, assessed trial quality, extracted data and updated the review.
Su Ern Yeoh selected trials for inclusion in the review, assessed trial quality and extracted data.
Dr Bryan Conway assisted in writing the review.
Sources of support
Internal sources
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No sources of support supplied
External sources
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The Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK.
The PVD Group editorial base is supported by the Chief Scientist Office.
Declarations of interest
SJ: none known
SEY: none known
BRC: none known
Acknowledgements
We would like to thank the Cochrane Peripheral Vascular Diseases Group Trials Search Co‐ordinator for searching for trials and Rachel Bedenis of the Cochrane Peripheral Vascular Diseases Group for assisting with data extraction from the CORAL trial.
The authors also thank Drs AJ Nordmann and AG Logan for their work on earlier versions of this review.
Version history
| Published | Title | Stage | Authors | Version |
| 2014 Dec 05 | Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis | Review | Sara Jenks, Su Ern Yeoh, Bryan R Conway | |
| 2003 Jul 21 | Balloon angioplasty versus medical therapy for hypertensive patients with renal artery obstruction | Review | Alain J Nordmann, Alexander G Logan | |
Differences between protocol and review
The review title was amended from 'Balloon angioplasty versus medical therapy for hypertensive patients with renal artery obstruction' to 'Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis' to reflect the content of the review more accurately.
The secondary outcome 'presence or absence of patency of the renal artery' has been revised to 'presence or absence of restenosis of the renal artery' to reflect more accurately the intended outcome.
We performed an additional subgroup analysis restricting all the meta‐analyses to the five studies that carried out angioplasty with stenting rather than angioplasty alone to assess the effect of improving angiographic techniques.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICO
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Balloon angioplasty versus medical therapy, Outcome 1 Change in systolic BP at 2 years or end of follow‐up.
Comparison 1 Balloon angioplasty versus medical therapy, Outcome 2 Change in diastolic BP at 2 years or end of follow‐up.
Comparison 1 Balloon angioplasty versus medical therapy, Outcome 3 Serum creatinine at 2 years or end of follow up.
Comparison 1 Balloon angioplasty versus medical therapy, Outcome 4 Number of antihypertensive drugs.
Comparison 1 Balloon angioplasty versus medical therapy, Outcome 5 Cardiovascular adverse events.
Comparison 1 Balloon angioplasty versus medical therapy, Outcome 6 Renal adverse events.
| Complications | ASTRAL | CORAL | DRASTIC | EMMA | NITER | SNRASCG | STAR |
| Angina/myocardial infarction/heart failure | 112 in BA, 131 in MT | 40 in BA, 37 in MT | 0 in BA, 2 in MT | 0 in any group | Data not available | 4 in each group | 4 in BA, 6 in MT (defined as CAD + HF) |
| Cholesterol embolisation | 3 in BA, 0 in MT | 6 in BA, 0 in MT | 0 in BA, 1 in MT | 0 in any group | Data not available | 0 in any group | 1 in BA, 0 in MT |
| Non‐procedure‐related symptomatic hypotension | Data not available | Data not available | 0 in any group | 0 in BA, 1 in MT | Data not available | 0 in any group | Data not available |
| Stroke | 24 in BA, 23 in MT | 16 in BA, 23 in MT | 0 in any group | 0 in any group | 3 in BA, 4 in MT | 1 in BA, 4 in MT | 0 in BA, 1 in MT (defined as cerebro vascular disease) |
| Death | 103 in BA, 106 in MT | 63 in BA, 76 in MT | 0 in any group | 0 in any group | 3 in BA, 3 in MT | 2 in BA, 4 in MT | 6 in MT, 5 in BA |
| BA: balloon angioplasty group | |||||||
| Complications | ASTRAL | CORAL | DRASTIC | EMMA | NITER | SNRASCG | STAR |
| > 50% increase in serum creatinine or | Data not available | Data not available | 1 in BA, 3 in MT | 0 in BA, 1 in MT | Data not available | 0 in any group | 10 in BA, 16 in MT (data provided for 20% fall in CrCl only) |
| Renal failure | 55 in BA, 54 in MT (defined as AKI + dialysis for end stage renal disease) | 16 in BA, 8 in MT (defined as permanent RRT) | 0 in any group | 0 in any group | 10 in BA, 8 in MT (but unclear how worsening renal failure was defined) | 2 in each group | Data not available |
| Total occlusion of stenotic artery | 5 in BA, 4 in MT | Data not available | 0 in BA, 4 in MT | 0 in any group | Data not available | 0 in any group | Data not available |
| AKI: acute kidney injury | |||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Change in systolic BP at 2 years or end of follow‐up Show forest plot | 5 | 1743 | Mean Difference (IV, Fixed, 95% CI) | ‐1.07 [‐3.45, 1.30] |
| 2 Change in diastolic BP at 2 years or end of follow‐up Show forest plot | 4 | 809 | Mean Difference (IV, Fixed, 95% CI) | 0.00 [‐3.72, ‐0.27] |
| 3 Serum creatinine at 2 years or end of follow up Show forest plot | 3 | 725 | Mean Difference (IV, Fixed, 95% CI) | ‐7.99 [‐22.60, 6.62] |
| 4 Number of antihypertensive drugs Show forest plot | 3 | 1717 | Mean Difference (IV, Fixed, 95% CI) | ‐0.18 [‐0.34, ‐0.03] |
| 5 Cardiovascular adverse events Show forest plot | 7 | 2110 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.91 [0.75, 1.11] |
| 6 Renal adverse events Show forest plot | 7 | 2104 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 1.02 [0.75, 1.38] |
