Clinical Studies
Nitric Oxide and Oxidative Stress in Atherosclerotic Renovascular Hypertension: Effect of Endovascular Treatment

https://doi.org/10.1097/01.RVI.0000083841.97061.12Get rights and content

PURPOSE

Because activation of the renin–angiotensin system leads to an increase in oxidative stress, the authors investigated nitric oxide (NO; nitrite + nitrate), superoxide dismutase (SOD), catalase, and malondialdehyde (MDA) levels and the effect of endovascular treatment on these parameters in patients with atherosclerotic renovascular hypertension. The relationship of NO with blood pressure and renal functional indexes was also investigated.

MATERIALS AND METHODS

In this prospective cohort study, serum creatinine, NO, SOD, catalase, plasma MDA, urinary microalbumin, and NO levels, and blood pressure were determined in 21 patients with hypertension and unilateral renal artery stenosis caused by atherosclerosis at entry and after 24 hours, 2 weeks, and 6 weeks of endovascular treatment.

RESULTS

MDA concentrations decreased 24 hours after intervention and remained low 2 and 6 weeks later. In addition, serum SOD and NO and urine NO levels were increased significantly 24 hours after endovascular treatment and decreased after 2 and 6 weeks. However, serum catalase levels did not differ after the intervention. Blood pressures decreased after treatment. There were no significant differences in urinary microalbumin levels, estimated glomerular filtration rates, and creatinine levels after endovascular treatment.

CONCLUSION

Endovascular treatment decreases oxidative stress and may offer new benefits in the treatment of patients with hypertension associated with renal artery stenosis. The decrease in oxidative stress and/or the upregulation of SOD may increase the bioavailability of NO, which in turn may lead to the rapid hypotensive response.

Section snippets

Patient Population

Between March 2000 and April 2002, we recruited consecutive patients referred to the interventional radiology unit for the treatment of renal artery stenosis. They had renal artery stenosis confirmed by color Doppler ultrasonography (US). Twenty-one subjects (16 men and 5 women; mean age, 60.4 years ± 14.7 [SD]; body mass index, 21.4 kg/m2 ± 3.4) were enrolled in the study. All subjects gave written informed consent.

Subjects with systolic blood pressures of 130–139 mm Hg and diastolic pressures

RESULTS

Renal artery stenosis was rightsided in eight patients and left-sided in 13. Nine patients had stenoses that were relatively moderate (50%–70%) and 12 had stenoses greater than 70%. Nineteen patients with ostial stenoses required stent placement. No adverse event in any patient occurred within 30 days of the procedure. Renal artery stenosis recurred after 7 months in one diabetic patient treated with stent placement. This patient was treated again by endovascular methods. All other follow-up

DISCUSSION

Oxygen free radicals or activated oxygen have been implicated in diverse environmental stresses and appear to participate commonly in most degenerative conditions. The peroxidation of lipids and the cross-linking and inactivation of proteins and mutations in DNA are typical consequences of free radicals, but because the reactions occur quickly and are often components of complex chain reactions, we can usually detect only their “footprints.” The mechanisms by which oxygen radicals damage

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