This study investigated whether patients receiving renin-angiotensin system inhibitors (RASIs) can undergo reliable screening for primary aldosteronism (PA) without discontinuation of therapy. Consecutive patients with hypertension who underwent PA screening at our hospital between 2016 and 2024 while on RASIs were recruited. Plasma aldosterone concentration (PAC) and direct renin concentration (DRC) were measured at three time points: pre-washout, post-washout, and post-captopril-challenge test (CCT). Subsequently, the aldosterone-to-renin ratio (ARR) was calculated, and PAC, DRC, and ARR were compared across time points. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal diagnostic cutpoints. A total of 412 patients on RASIs, with or without calcium-channel blockers (CCBs) or α1-receptor antagonists, were analyzed. Among these, 175 had PA and 237 had essential hypertension (EH). PAC, DRC, and ARR were significantly different between the PA and EH groups across all three time points. Within the PA cohort, PAC (p < 0.001) and ARR (p = 0.016) differed significantly between the pre-washout and post-CCT measurements, whereas DRC did not (p = 0.456). The optimal pre-washout ARR cutpoint of 2.69 demonstrated a sensitivity of 83.3%, specificity of 87.2%, positive predictive value (PPV) of 82.2%, and negative predictive value (NPV) of 88.1% for diagnosing PA. These findings indicate that pre-washout PAC, DRC, and ARR retain high diagnostic performance for PA in patients treated with RASIs, provided that other agents affecting the renin-angiotensin-aldosterone system are not co-administered.

Objective Our purpose is to compare the clinical outcomes of the covered endovascular reconstruction of the aortic bifurcation (CERAB) and the kissing stent technique in the treatment of aortoiliac occlusive disease (AIOD). Methods We conducted a retrospective review of consecutive patients with AIOD who underwent either CERAB or kissing stent procedures at a tertiary referral center in China between December 2015 and January 2025. Baseline characteristics, procedural details, ankle-brachial index (ABI), early complications, and patency rates were compared. Kaplan–Meier analysis assessed primary/secondary patency and freedom from reintervention. Multivariate Cox regression analysis was performed to identify the independent predictors of primary patency. Results A total of 75 AIOD patients were included, including 57 patients (76.0%) in the Kissing stent group and 18 patients (24.0%) in the CERAB group. Technical success (100% vs. 98.2%, P = 1.000) and 30-day mortality (0% vs. 3.5%, P = 1.000) did not differ significantly between the groups. Both groups showed significant ABI improvement. The 5-year primary patency was lower with CERAB (57.2% vs. 74.4%, P = 0.012), but the difference was nonsignificant after multivariate adjustment (P = 0.100). Secondary patency (88.5% vs. 89.8%, P = 0.180) and freedom from reintervention (61.4% vs. 78.9%, P = 0.170) were comparable. Multivariate analysis identified access route, femoral artery stenosis, and stent diameter as independent predictors of primary patency. Conclusions Both techniques are safe and effective. Anatomic factors and procedural details exert a greater influence on clinical outcomes than the choice of technique itself. Therefore, preprocedural planning should emphasize individualized anatomical assessment and meticulous surgical execution.

Background:The C-reactive protein-triglyceride-glucose index (CTI) and depression are each associated with elevated cardiovascular disease (CVD) risk. However, evidence on long-term cumulative CTI exposure and its joint effect with depression remains limited. Methods:This prospective cohort study included participants from the 2015 baseline of the China Health and Retirement Longitudinal Study, with follow-up in 2018 and 2020. Cox proportional hazards models were used to examine associations between a combined cumulative CTI-depression indicator and incident CVD, as well as their interaction. Restricted cubic splines were used to assess dose-response relationships across depression status. The predictive performance of the composite indicator was compared with individual components using integrated discrimination improvement and net reclassification improvement. Subgroup and sensitivity analyses were conducted. Results:Participants were categorized according to cumulative CTI level and depression status. Compared with individuals with low cumulative CTI and no depression, all other groups exhibited significantly higher risks of CVD, demonstrating a clear graded association. These associations remained robust after multivariable adjustment. In the primary fully adjusted model, participants with high cumulative CTI and depression had the highest CVD risk (HR = 1.83, 95% CI 1.53-2.20, p < 0.01). Categorical analyses suggested possible effect modification by depression status. In addition, the combined cumulative CTI-depression indicator demonstrated improved predictive performance compared with either component alone. The primary associations remained broadly consistent across subgroup and sensitivity analyses, although evidence for possible effect modification varied across alternative analytical approaches. Conclusions:The combined cumulative CTI-depression indicator was strongly and consistently associated with increased CVD risk, exhibiting graded associations with possible effect modification by depression. This joint measure captures cumulative metabolic-inflammatory burden and psychological distress and may provide complementary information for cardiovascular risk stratification beyond the individual components.

OBJECTIVE:This meta-analysis aimed to evaluate the success rate and safety of adrenal venous sampling (AVS) via the antecubital approach and to compare these outcomes with the femoral approach. METHODS:A systematic search was performed in PubMed, Embase, Cochrane Library, Web of Science, and Wanfang Data from inception to May 1, 2025. The primary outcome was the success rate of right and left adrenal vein cannulation. Secondary outcomes included procedure-related complications, fluoroscopy time, and contrast agent volume. Comparative outcomes were reported as odds ratios (ORs) and weighted mean differences (WMDs). RESULTS:A total of 11 studies involving 2332 patients with primary aldosteronism undergoing AVS were included. The antecubital approach for AVS showed no statistically significant differences compared with the femoral approach in right adrenal vein cannulation success rate (antecubital single-arm pooled estimate: 91.9%, 95% CI: 85.26% to 95.70%; comparative analysis: OR 1.43, 95% CI: 0.23-9.04), left adrenal vein cannulation success rate (95.35%, 95% CI: 94.34% to 96.19%; OR 1.44, 95% CI: 0.63-3.28), procedure-related complications (0.36%, 95% CI: 0.07% to 0.79%; OR 0.51, 95% CI: 0.17-1.60), fluoroscopy time (7.64 minutes, 95% CI: 6.12-9.16; WMD 0.62 minutes, 95% CI: -0.75 to 1.99), or contrast agent volume (19.37 mL, 95% CI: 15.9-22.83; WMD 0.19 mL, 95% CI: -0.57 to 0.96). CONCLUSION:Antecubital AVS demonstrated acceptable success rates and safety, particularly in moderate- to high-volume centers, without clear inferiority to the femoral approach.

In this study, we investigated the applicability of the ankle-brachial index (ABI) and brachial-ankle index (BAI) in distinguishing aortic stenosis (AS) from lower-extremity arterial stenosis. The difference between the ABI on both sides (∆ABI) was defined as the absolute value of the left ABI minus the right ABI. Lower BAI (L-BAI) was defined as the value of the side with the lowest BAI. We obtained four-limb blood pressure measurement data from 6435 patients. AS and bilateral lower-extremity arterial stenosis (BLEAS) were diagnosed. The performance of combined bilateral ABI decline, ΔABI, and L-BAI in diagnosing AS was evaluated. The control group showed normal bilateral ABI values, whereas the AS and BLEAS groups exhibited a bilateral ABI decline. The BLEAS group had the highest ∆ABI compared to the other groups. L-BAI in the BLEAS and AS groups was higher than that in the control group. AS screening using bilateral ABI ≤0.90 combined with ΔABI ≤0.10 and L-BAI >1.00 yielded an area under the receiver operating characteristic curve of 0.873 and a Youden index, sensitivity, and specificity of 0.724, 85.2%, and 87.2%, respectively. Validation in 1004 patients revealed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 90.0%, 96.0%, 54.2%, 99.5%, and 95.7%, respectively. In conclusion, combining bilateral ABI ≤0.90, ∆ABI ≤0.10, and L-BAI >1.00 can effectively screen for AS; this is useful in distinguishing AS from BLEAS, especially in cases of bilateral decline in lower-extremity ABI values.

To compare the feasibility and safety of three approaches for bilateral adrenal venous sampling (AVS) and their influence on the outcomes of adrenalectomy for dominant lateral primary aldosteronism (PA). 182 PA patients who underwent AVS at Fuwai Hospital between January 2022 and March 2024 were enrolled. According to the puncture access, patients were divided into three groups: simultaneous AVS via antecubital approach group (Group A, N = 48), simultaneous AVS via femoral approach group (Group B, N = 44) and sequential AVS via antecubital approach group (Group C, N = 90). The baseline data, procedure parameters, success rates, complication rates and follow-up data were analyzed. The baseline characteristics did not differ significantly among three groups (all P > 0.05). The procedure time (18.9 ± 7.4 min vs. 25.2 ± 7.5 min; P < 0.001) and fluoroscopy time (7.1 ± 3.8 min vs. 10.8 ± 6.2 min; P < 0.001) were shorter in Group A than in Group C. However, there was no significant difference between Group A and B (all P > 0.05). The bilateral sampling success rates in Groups A, B and C were 93.8

This systematic review and meta-analysis study evaluated the clinical and biochemical efficacy of super-selective adrenal artery embolization (SAAE) in patients with primary aldosteronism (PA). The primary outcome was the change in office blood pressure, while secondary outcomes included changes in plasma aldosterone and serum potassium levels following the procedure. A systematic search of Embase, PubMed, Ovid, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed was conducted through December 14, 2024. Seventeen studies involving 650 patients (aged 28-65 years) with a median follow-up of 6 months were included. Meta-analysis, subgroup analysis, publication bias assessment, and sensitivity analysis were performed using RevMan 5.3 and R 4.2.3. The results showed that SAAE significantly reduced systolic (MD = -19.84 mmHg, 95% CI: -22.87 to -16.82 mmHg) and diastolic blood pressure (MD = -10.62 mmHg, 95% CI: -12.61 to -8.64 mmHg), lowered plasma aldosterone levels (MD = -90.99 pg/mL, 95% CI: -119.36 to -62.63 pg/mL), and increased serum potassium levels (MD = 0.59 mmol/L, 95% CI: 0.49-0.70 mmol/L). Subgroup analyses confirmed benefits in patients with both idiopathic hyperaldosteronism and aldosterone-producing adenoma. These findings support SAAE as an effective treatment for improving clinical outcomes and correcting biochemical abnormalities in PA.

OBJECTIVE:Management of supra-aortic artery stenosis caused by Takayasu's arteritis (SAASTA) by endovascular therapy remains an unresolved issue in clinical practice. This study investigated the peri-operative and long term outcomes of endovascular therapy in patients with SAASTA. METHODS:From January 2002 to December 2021, 219 consecutive patients with symptomatic SAASTA undergoing endovascular therapy were enrolled in this study. All lesions underwent percutaneous transluminal angioplasty with a plain balloon or a drug coated balloon. Adjunctive stent implantation was performed in cases of flow limiting dissections and or residual stenosis exceeding 50% following initial balloon dilatation. Peri-operative and long term clinical outcomes were recorded and analysed. RESULTS:Three hundred and seventy-five lesions were recanalised in 265 endovascular procedures. Supra-aortic artery related symptoms were relieved in 93.2% of patients after the initial procedure. Peri-operative neurological complications occurred in eight of 219 cases (3.7%). The overall rates of 30 day death and stroke were both 0.5%. Follow up data were available for 186 patients (84.9%) during a median follow up of 73.7 months (interquartile range 25.1, 126.3), and re-stenosis occurred in 155 (41.3%) of 375 lesions. Kaplan-Meier analysis demonstrated superior primary patency rates in lesions managed with balloon angioplasty alone, including both plain balloons (42.7%) and drug coated balloons (64.0%), compared with lesions requiring adjunctive stenting (26.6%; p = .024 for plain balloon vs. stent, p = .032 for drug coated balloon vs. stent). No statistically significant difference was observed between the two balloon only strategies (p = .35). Adjunctive stent placement (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.02 - 2.34; p = .042) and active inflammation (HR 1.54, 95% CI 1.03 - 2.30; p = .036) were independent predictors of re-stenosis. The recurrence rates of SAASTA related symptoms at one, five, and ten years were 15.2%, 26.7%, and 34.1%, respectively. The cumulative composite clinical event free survival rates at these time points were 98.9%, 90.2%, and 82.6%, respectively. CONCLUSION:Endovascular therapy was safe and effective for patients with SAASTA. Post-operative re-stenosis was a major challenge, particularly in lesions requiring adjunctive stenting.

IMPORTANCE:Femoral vein access used to be the traditional approach for adrenal venous sampling (AVS) procedures, whereas antecubital vein access is the newly developed approach. Until now, no randomized trial for comparison of two approaches has been carried out. OBJECTIVE:To compare the success rate, safety, and procedural parameters of AVS via an antecubital approach versus femoral approach. DESIGN:This randomized clinical trial (RCT) was conducted between January 2022 and December 2023. The patients with primary aldosteronism (PA) aged 18-60 years were randomly assigned to femoral vein access group (FV) or antecubital vein access group (AV). The intention-to-treat analysis included all randomized patients. PARTICIPANTS:A total of 675 patients aged 18-60 years old with hypertension that were at increased risk for PA were screened, 183 of whom were confirmed with PA. Twenty-nine patients were excluded due to refusal of AVS, decline of participating in this trial, or contraindication to AVS. A total of 154 patients were recruited in this trial. INTERVENTION:Patients were randomly assigned to undergo AVS via femoral approach or antecubital approach. MAIN OUTCOMES AND MEASURES:The primary end point was the success rate of bilateral AVS. Secondary end points included the success rate of right, left sampling, procedure duration, fluoroscopy time, contrast volume, incidence of complications, and postsurgical outcomes. RESULTS:From January 2022 to December 2023, totally 154 patients with PA were randomized to FV group (77cases, mean age, 47.8 ± 8.1 years; 26 females [33.8%]) and AV group (77cases, mean age, 49.2 ± 8.6 years; 30 females [39%]). The baseline characteristics for the two groups were well balanced ( P > 0.05). There were no significant differences in the success rate of bilateral (89.6% vs 92.2%, P = 0.58),right (94.8% vs 97.4%, P = 0.68), and left (94.8% vs 94.8%, P = 1.00) sampling between two groups. The incidence of complications did not differ between the two groups (2.6% vs 0, P = 0.477). The incidence of arterial mis-puncture was significantly higher in FV group than that in AV group (0% vs 9.1%, P = 0.02). The fluoroscopy time and contrast volume did not significantly differ between two groups. The procedure duration in AV group was significantly shorter than that of FV group (18.0 [IQR, 15.0-23.0] versus 20.0 [IQR, 17.0-25.5], P = 0.011). There was no significant difference in the proportion of patients who achieved complete clinical success (50.0% vs 45.9%, P = 0.725) and complete biochemical success (92.1% vs 91.9%, P = 1.000) after adrenalectomy between FV group and AV group. CONCLUSION AND RELEVANCE:The trial showed AVS via AV approach or FV approach did not lead to significant differences in success rate and incidence of complications, as well as postsurgical outcomes. However, AV approach was associated with shorter procedure duration, no arterial mis-puncture and earlier ambulation after the procedure, which make it a better alternative to FV approach.

This study aimed to compare the blood pressure-lowering efficacy and safety of different renal denervation (RDN) techniques. We systematically searched PubMed, Ovid, and Embase up to September 4, 2025. The primary outcome was the change in 24 h ambulatory systolic blood pressure from baseline to the end of follow-up. Secondary outcomes included changes in 24 h ambulatory diastolic blood pressure and the incidence of major adverse events. Two reviewers independently conducted study screening, data extraction, and risk of bias assessment. A network meta-analysis, along with sensitivity and subgroup analyses, was performed. Our analysis indicated that both radiofrequency RDN of the main renal artery and branches (RFB-RDN) and ultrasound RDN (US-RDN) were associated with significant reductions in 24 h ambulatory blood pressure, with comparable efficacy between the two approaches, whereas radiofrequency RDN of the main renal artery (RFM-RDN) and alcohol-mediated RDN (ALC-RDN) showed limited efficacy. Compared with sham, US-RDN and RFM-RDN showed trends toward fewer adverse events, whereas RFB-RDN and ALC-RDN exhibited numerically higher risks; however, these differences did not reach statistical significance. Subgroup analyses suggested that hypertension subtype, ethnicity, and baseline blood pressure may influence treatment effects, particularly for RFB-RDN.

ABSTRACT We conducted a retrospective cohort study to investigate changes in the aldosterone‐to‐renin ratio (ARR) and other influencing factors in patients with renal artery stenosis (RAS) and primary aldosteronism (PA). Patients with RAS and PA admitted to our hospital between January 2016 and December 2021 were retrospectively selected. Based on the standardized PA screening results, the patients were divided into aldosterone‐to‐renin ratio‐positive and ‐negative groups. The clinical features of the patients were compared. Binary logistic regression analysis was performed to identify the factors contributing to the comorbidity of RAS with false‐negative PA. A total of 78 patients (mean age: 60.2 ± 10.2 years) were selected, among whom 46 (59%) were male. Overall, 69 patients had Stage 3 hypertension (88.5%) and 57 had hypokalemia (73.1%). Additionally, 42 (53.8%) and 36 (46.2%) patients were aldosterone‐to‐renin ratio‐positive and ‐negative, respectively. The aldosterone‐to‐renin ratio‐positive group showed significant differences in malignant hypertension (2.4% vs. 27.8%; p = 0.002), Stage 3 hypertension (81.0% vs. 97.2%; p = 0.033), and RAS degree (64.3 ± 16.4% vs. 71.8 ± 14.4%; p = 0.032). Malignant hypertension (odds ratio, 15.250; 95% confidence interval, 1.787–130.132; p = 0.013) and RAS degree (odds ratio, 1.034; 95% confidence interval, 1.002–1.068; p = 0.036) influenced the comorbidity of RAS with false‐negative PA. Malignant hypertension and severe RAS can contribute to false‐negative PA results. Therefore, PA screening test results should be carefully analyzed and rechecked following RAS treatment to confirm the presence of PA.

Context Adrenal venous sampling (AVS) is considered the gold standard for differentiating unilateral and bilateral forms of primary aldosteronism. Currently, almost all AVS procedures are performed via femoral vein access. Objective The aim of this study was to evaluate the success rate and safety of AVS via an antecubital approach. Methods In a retrospective multicenter study involving 7 Chinese medical centers, patients with primary aldosteronism who underwent AVS via an antecubital approach between January 2012 and December 2018 were analyzed. Successful sampling was determined by a selectivity index (cortisol in the adrenal vein/cortisol in inferior vena cava) greater than 2. Results A total of 1226 participants (mean age, 47.1 years; 57.9% male) were included. The puncture site was right and left antecubital vein in 1211 (98.8%), and 15 (1.2%) patients. The access of 6 patients (0.5%) was changed to right femoral vein due to the failure of antecubital vein cannulation or anatomic variation of adrenal vein. The success rate of bilateral, right, and left sampling was 91.5%, 94.9%, and 95.1%, respectively. The success rate of bilateral, right, and left sampling increased from 82.9%, 87.1%, and 88.6% during the initial 70 cases (total of initial 10 cases at each center) to 92.0% (P = .012), 95.3% (P = .008), and 95.5% (P = .018) with subsequent cases. Adrenal vein rupture occurred in 5 patients (0.41%), with no sequelae. Conclusion This multicenter study demonstrates that AVS via an antecubital approach is safe and feasible, with a high rate of successful sampling, which may be an alternative to the femoral vein access method.

ABSTRACT To evaluate the long‐term efficacy and safety of transfemoral access (TFA) versus upper extremity access (UEA) for renal denervation (RDN) based on vascular morphology. This study retrospectively enrolled patients with resistant hypertension who underwent RDN treatment via TFA and UEA (brachial, radial, and ulnar artery) at the Fuwai Hospital between February 2012 and November 2019. Follow‐up was conducted at 6 months, 1 year, and 3 years after RDN, and the last visit was June 2023. A total of 85 patients were enrolled, 58 (68.2%) of them were treated via TFA, and 27 patients (31.8%) via UEA. The fluoroscopy time was less in the TFA group (12.2 ± 5.7 min vs. 15.2 ± 7.2 min; p = 0.038). The procedure time (TFA group: 40.8 ± 14.9 min vs. UEA group: 38.6 ± 11.6 min; p = 0.506), contrast volume (TFA group: 78.2 ± 25.9 mL vs. UEA group: 91.9 ± 39.7 mL; p = 0.061) were similar between two groups, without procedure‐related complications. Fifty‐eight participants completed the last visit with a 3–12 year of follow‐up (9.5 ± 1.3 years). Compared with baseline, there were no significant differences in the change of office systolic blood pressure (−12.6 ± 21.6 mmHg vs. −13.1 ± 22.8 mmHg; p = 0.933), 24‐h mean systolic blood pressure (−11.9 ± 14.2 mmHg vs. −11.3 ± 15.3 mmHg; p = 0.899), the number of antihypertensive drugs, and renal function between two groups. There were three adverse events in the TFA group (3 of 58 patients, 5.2%) versus one (1 of 27 patients, 3.7%) in the UEA group, without a significant difference between the two groups. The study showed RDN via UEA was feasible using a special‐designed catheter, particularly in patients with illegal vascular morphology via TFA.

Juxtaglomerular cell tumors (JGCTs) or reninoma are rare kidney tumors leading to secondary hypertension, and the non-specific clinical manifestations bring about challenges to the diagnosis. This study is to summarize the clinical features, laboratory findings, and treatment of JGCTs. The PubMed, EMBASE database, and manual search were utilized to find all cases, and 158 reports containing 261 patients were identified. Data on patients' demographics, clinical features, diagnostic methods, and treatment options were collected and analyzed. JGCTs occurred predominantly in female patients (female to male ratio, 2.1:1). The median age of patients was 25 years (IQR:18-34 years). Hypertension (97.24%) was the cardinal manifestation. Hypokalemia was reported in 78.71% (159/202) of subjects, and normal serum potassium accounted for 20.79% (42/202). In cases with assessed plasma renin activity (PRA) levels, the median PRA was 7.89 times the upper limit of normal (IQR:3.58-14.41), and 3.82% (5/131) of cases in the normal range. Tumors were detected in 97.8% (175/179) computed tomography (CT), 94.7% (72/76) magnetic resonance imaging (MRI), and 81.5% (110/135) ultrasound, respectively. For 250/261 patients undergoing surgical procedures, 89.14% (197/221), 94.94% (150/158), and 100% (131/131) of patients were restored to normal blood pressure, PRA, and serum potassium, respectively. JGCTs are commonly associated with hypertension, hypokalemia, and hyperreninemia, whereas patients with normotension, normokalemia, and PRA should be systematically pursued after drug-elution lasting for 2 weeks. CT and MRI are more sensitive imaging diagnostic methods. The blood pressure and biochemical parameters of most patients returned to normal after surgery.

BACKGROUND: Renal denervation (RDN) can lower blood pressure (BP) in patients with hypertension in both the presence and absence of medication. This is a sham-controlled trial investigating the safety and efficacy of RDN in China. METHODS: This prospective, multicenter, randomized, patient- and outcome-assessor-blinded, sham-controlled trial investigated radiofrequency RDN in patients with hypertension on standardized triple antihypertensive therapy. Eligible patients were randomized 1:1 to undergo RDN using a multi-electrode radiofrequency catheter (Iberis; Shanghai Angiocare Medical Technology, Shanghai, China) or a sham procedure. The primary efficacy outcome was the between-group difference in baseline-adjusted change in mean 24-hour ambulatory systolic BP from randomization to 6 months. RESULTS: Of 217 randomized patients (mean age, 45.3 +/- 10.2 years; 21% female), 107 were randomized to RDN and 110 were randomized to sham control. At 6 months, there was a greater reduction in 24-hour systolic BP in the RDN (-13.0 +/- 12.1 mm Hg) compared with the sham control group (-3.0 +/- 13.0 mm Hg; baseline-adjusted between-group difference, -9.4 mm Hg [95% CI, -12.8 to -5.9]; P<0.001). Compared with sham, 24-hour diastolic BP was lowered by -5.0 mm Hg ([95% CI, -7.5 to -2.4]; P<0.001) 6 months after RDN, and office systolic and diastolic BP was lowered by -6.4 mm Hg ([95% CI, -10.5 to -2.3]; P=0.003) and -5.1 mm Hg ([95% CI, -8.2 to -2.0]; P=0.001), respectively. One patient in the RDN group experienced an access site complication (hematoma), which resolved without sequelae. No other major device- or procedure-related safety events occurred through follow-up. CONCLUSIONS: In this trial of Chinese patients with uncontrolled hypertension on a standardized triple pharmacotherapy, RDN was safe and reduced ambulatory and office BP at 6 months compared with sham. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02901704.

Hypertension constitutes a critical risk factor for cardio-cerebrovascular disease. Despite the effectiveness of lifestyle adjustments and medications in blood pressure (BP) management, the hypertension control rates remain inadequate. Percutaneous renal denervation (RDN) has emerged as a forward-looking and evidence-supported interventional modality for the improvement of BP regulation and enhancement of hypertension control. Comprehensive evidence from randomized, sham-controlled clinical trials supports the sustained the efficacy and satisfactory safety profile of RDN in lowing BP. This scientific statement, endorsed by Chinese authorities, aims to provide a comprehensive overview of global and national clinical evidence on RDN. It seeks to highlight the therapeutic advancements of RDN, articulate expert consensus and recommendations for its utilization in hypertension management. Through the promotion of structured, safe, and standardized incorporation of RDN into clinical practice, this statement strives to optimize hypertension treatment within the Chinese medical community.

Objective: Fibromuscular dysplasia (FMD) is a noninflammatory arterial disease that predominantly affects women. The arterial manifestations may include beading, stenosis, aneurysm, dissection, or tortuosity. This study compared the frequency, location, and outcomes of FMD patients with aneurysm and/or dissection to those of patients without. Design and method: Consecutive hypertensive patients with renal artery stenosis caused by FMD underwent catheter-based angiography, followed at two Chinese referral centers in China between January 2000 and Ouctober 2023. Results: Aneurysm occurred in 71 patients (24.6%) and dissection in 13 patients (4.5%); in total, 84 patients (29.0%) had an aneurysm and/or a dissection by the time of FMD diagnosis. The extracranial carotid, renal, and intracranial arteries were the most common sites of aneurysm; dissection most often occurred in the extracranial carotid, vertebral, renal, and coronary arteries. FMD patients with dissection were elder at presentation (37.6 vs. 26.5 years of age, respectively; p < 0.0001) and experienced more eurological symptoms and other end-organ ischemic events than those without dissection. One-fifth of aneurysm patients (14 of 71) underwent therapeutic intervention for aneurysm repair. Conclusions: Chinese patients with renal artery FMD had a lower prevalence of dissection at the time of FMD diagnosis than Caucasians, but similar prevalence of aneurysm. Patients with dissection were more likely to experience ischemic events, and a significant number of patients with dissection or aneurysm underwent therapeutic procedures for these vascular events. Because of the high prevalence and associated morbidity in patients with FMD who have an aneurysm and/or dissection, it is recommended that every patient with FMD undergo one-time cross-sectional imaging from head to pelvis with computed tomographic angiography or magnetic resonance angiography.

Background: Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects renal arteries. There is growing awareness of this disease entity. However, most of the previous studies have been from US or European populations. Methods: Consecutive hypertensive patients with renal artery stenosis caused by FMD underwent catheter-based angiography, followed at two Chinese referral centers in China between January 2000 and December 2021. Results: Of 245 study participants, with a mean diagnosed age of 26.9 ± 9.9 years, 137 (55.9%) were female, 38 (15.5%) were children. All patients had diagnosed hypertension at a mean age of 23.4 ± 8.4 years. 73.5% were focal and 15.2% were multivessel. Aneurysms, arterial dissections, and total occlusions were found in 21.6%, 4.1% and 12.2% of patients, respectively. Patients with multifocal FMD, compared to those with focal FMD, were older (26.0 vs.23.7 years, P = 0.021) and more often female (70.8% vs. 50.6%, P = 0.004), had a higher proportion of renal artery dissection (9.2% vs. 2.2%, P = 0.014), lower proportion of kidney atrophy (18.5% vs.31.1%, P = 0.013), and had fewer antihypertensive drugs (1.7 vs. 2.1, P = 0.002). After a median of 6.9 years follow-up, multifocal FMD had a higher cure rate of hypertension than focal FMD after revascularization (71.2% vs.55.2%, P = 0.033). Conclusions: Chinese patients with renal artery FMD had different characteristics from Caucasians, especially in adults. In Chinese, renal artery FMD occurred primarily in the young hypertensive patients with little sex predilection, and was frequently focal, which showed a worse blood pressure outcome than multifocal.