ABSTRACT This retrospective cohort study preliminarily investigated the feasibility of implementing primary aldosteronism (PA) screening without discontinuing dihydropyridine calcium channel blockers (DHP‐CCBs). We screened all patients undergoing diagnostic testing for secondary hypertension from January 2017 to May 2022 at authors’ center. For inclusion, patients must be on DHP‐CCBs monotherapy for hypertension. Aldosterone and renin concentration were measured pre‐ and post‐washout. Confirmatory tests were conducted in patients with positive screen [combination of ARR >2.5 (ng/dL)/(μIU/mL), aldosterone ≥10 ng/dL, and renin ≤8.2 μIU/mL] after washout. The final analysis included a total of 198 patients (median age: 49.5 years and 117 men). Confirmatory tests identified PA in 31 (15.7%) patients. Aldosterone‐to‐renin ratio (ARR) increased in 158 (79.8%) patients after washout. In 168 patients with a negative pre‐washout screen, 22 turned positive after washout, and 14 were diagnosed PA. Consequently, the missed diagnosis rate of PA was 45.2% (14/31) when using standard positive screen criteria before washout of DHP‐CCBs monotherapy. Exploratory analysis indicated that a pre‐washout ARR cutoff of >1.2 (ng/dL)/(μIU/mL) demonstrated 0.97 sensitivity and 0.75 specificity. In conclusions, caution is warranted when interpretating screening results from patients on DHP‐CCBs monotherapy due to the potential risk of missed diagnosis. Preliminary data suggest that ARR ≤1.2 (ng/dL)/(μIU/mL) before washout may serve as a candidate threshold for excluding PA in these patients, though this observation remains a hypothesis‐generating finding that requires further investigation.

In August 2025, the American Heart Association, American College of Cardiology, and more than ten other academic organizations jointly released an updated guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Integrating the latest clinical evidence, the new guideline reflects a risk-based approach centered on "comprehensive blood pressure control" and "lifespan management." It provides more proactive recommendations on hypertension diagnosis criteria, intensive blood pressure-lowering strategies, secondary hypertension screening, antihypertensive pharmacotherapy and device-based therapies. This updated guideline holds significant implications for refining hypertension prevention and management strategies in China.

This study aimed to assess the accuracy of the CONTEC08C automated oscillometric upper-arm sphygmomanometer in adults for clinical use in accordance with the ISO 81060-2:2018 standard. A total of 90 normotensive and hypertensive participants aged 18-75 years were recruited, and 85 were analyzed to evaluate the accuracy of the CONTEC08C oscillometric upper-arm sphygmomanometer using the same arm sequential validation method and a standardized protocol. The mean ± standard deviation (SD) of the differences between the test device and reference blood pressure (BP) measurements was 0.5 ± 3 mmHg for SBP and 0.4 ± 3.5 mmHg for DBP, meeting validation criterion 1. For validation criterion 2, the SD of the averaged differences between the test device and reference BP measurements per subject was 1.81/2.41 mmHg (systolic/diastolic). The CONTEC08C oscillometric upper-arm blood pressure monitor fulfilled the requirements of the ISO 81060-2:2018 standard in adults in the clinical setting and can therefore be recommended for safe clinical use.

To improve the standard screening, diagnosis, and treatment of hypertension in patients in China; realize the standardization of clinical practice of hypertension; and improve the prevention and control level of hypertension in China, it is both important and necessary to develop a clinical practice guideline for hypertension according to a recognized methodology. Jointly sponsored by the National Center for Cardiovascular Diseases, Chinese Medical Doctor Association, Hypertension Committee of the Chinese Medical Doctor Association, Chinese Society of Cardiology, and Hypertension Committee of Cross-Straits Medicine Exchange Association, the “Chinese Clinical Practice Guidelines of Hypertension” was proposed. Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, Guideline and Standards Research Centre of Chinese Medical Association Publishing House, Lanzhou University Institute of Health Data Science, and Lanzhou University GRADE Center will provide methodological support for the guidelines.

Patients who undergo adrenalectomy for unilateral primary aldosteronism (PA) may still develop post-surgery hypertension; however, the clinical characteristics and etiology of patients developing recurrent hypertension after adrenalectomy are unclear. We analyzed the records of 43 patients with recurrent elevated blood pressure after adrenalectomy, who were treated at our center. Standard routine clinical screening workup was used to identify the cause of recurrent hypertension. Causes of recurrent hypertension after adrenalectomy included essential hypertension, primary aldosteronism, obstructive sleep apnea, renal artery stenosis, and Takayasu arteritis. Before adrenalectomy, 39.5% of patients were diagnosed with confirmed or suspected PA, primarily through CT imaging. Adrenal venous sampling (AVS) tests were not conducted on any patients, and 72.1% patients underwent partial adrenalectomy. Among all patients, elevated blood pressure was observed in 44.2% immediately post-operation, 18.6% within 1 month, 16.3% in 1–6 months, and 20.9% >6 months after operation. Most patients had hypertension of grade 2 and above. Standard endocrine functional assessment and AVS tests should be performed before adrenalectomy to ensure more accurate diagnosis and favorable post-operative outcomes. Additionally, individuals often develop essential hypertension regardless of past adrenal disease.

Metabolite profiling has the potential to comprehensively bridge phenotypes and complex heterogeneous physiological and pathological states. We performed a metabolomics study using parallel liquid chromatography-mass spectrometry (LC-MS) combined with multivariate data analysis to screen for biomarkers of primary aldosteronism (PA) from a cohort of 111 PA patients and 218 primary hypertension (PH) patients. Hydrophilic interaction chromatography and reversed-phase liquid chromatography separations were employed to obtain a global plasma metabolome of endogenous metabolites. The satisfactory classification between PA and PH patients was obtained using the MVDA model. A total of 35 differential metabolites were screened out and identified. A diagnostic biomarker panel was established using the least absolute shrinkage and selection operator (LASSO) binary logistic regression model and receiver operating characteristic analysis. Joint analysis with clinical indicators, including plasma supine aldosterone level, plasma orthostatic aldosterone level, body mass index, and blood potassium, revealed that the combination of metabolite biomarker panel and plasma supine aldosterone has the best clinical diagnostic efficacy.

OBJECTIVE:The aim of this study is to evaluate performance of aldosterone-to-renin ratio (ARR) before washout of antihypertensive drugs as a screening test for primary aldosteronism (PA). METHODS:This retrospective analysis included consecutive patients screening for secondary hypertension during a period from January 2017 to May 2022 at the authors' institute. For inclusion in the final analysis, ARR had to be available prior to as well as after discontinuation of antihypertensives. Patients with ARR ≥2.4(ng/dL)/(μIU/mL) after washout proceeded to confirmatory tests. Diagnosis of PA was established based on a positive result of the confirmatory test. The diagnostic accuracy of ARR prior to the washout in predicting PA is shown as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS:The analysis included a total of 1306 patients [median age of 50.2 (41.0-59.0) years, 64.0% male]. Confirmatory tests showed PA in 215(16.5%) patients and essential hypertension (EH) in the remaining 1091(83.5%) patients. In comparison to the second screening test, the first screening test (before washout of antihypertensives) yielded lower plasma aldosterone and higher renin and consequently lower ARR in both the PA and EH groups. At a cutoff of .7(ng/dL)/(μIU/mL), ARR before washout had 96.3% sensitivity, 61.2% specificity, .33 PPV, and .99 NPV. At a lower cutoff of .5(ng/dL)/(μIU/mL), the sensitivity, specificity, PPV, and NPV were 97.7%, 52.0%, .29, and .99, respectively. CONCLUSION:ARR prior to washout of antihypertensives is a sensitive screening test for PA. Washout of antihypertensives could be omitted and further investigation for PA is not warranted if ARR is ≤ .7(ng/dL)/(μIU/mL) before washout.

Background and aim: The purpose of this meta-analysis was to evaluate the dose-response relationship between dietary cholesterol (DC) consumption and the incidence of type 2 diabetes mellitus (T2DM). Methods and results: Prospective studies with the endpoint of T2DM were included. The Random-effect model weighted by inverse variance was used. Meta-regression and subgroup an-alyses were conducted to explore the potential sources of heterogeneity by specified study char-acteristics. Restricted cubic splines regression models were used to estimate the dose-response relationship. 11 prospective studies comprising of 355 230 subjects were included. Compared to lowest DC consumption, highest DC consumption was associated with an increased risk of T2DM (RR 1.15, 95% CI 1.03 to 1.28, P = 0.012; chi-squared = 31.41, I-squared 58.6%, P heterogeneity = 0.003). Subgroup analyses have shown that this positive association was more evident in western countries than in eastern countries (RR 1.19, 95% CI 1.06 to 1.36 VS 1.34, 95% CI 0.84 to 1.29; P subgroup difference = 0.02). For 100 mg/d increment in DC intake, the pooled RR was 1.05, (95% CI 1.04 to 1.07, Plinearity = 0.000, Pnonlinearity = 0.02), 1.06 (95% CI 1.04 to 1.07, Plinearity=0.000), and 1.01 (95% CI 0.98 to 1.05, Plinearity = 0.525) for the incidence of T2DM, in western and eastern countries, respectively. Conclusions: Our study suggests that there is a positive dose-response association between DC consumption and the incidence of T2DM, especially in western countries. Systematic review registration: PROSPERO CRD42020216318. & COPY; 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Ital-ian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Background: Mid-aortic syndrome (MAS), characterized by segmental stricture of the distal thoracic and abdominal aorta, is a heterogeneous clinical syndrome with multiple etiologies. Methods: We retrospectively analyzed 143 consecutive patients (99 females and 44 males, mean age 40.93 +/- 15.31 years) with MAS seen from January 1, 2010 to January 1, 2019. Results: Takayasu arteritis (76.9%, 110/143) and atherosclerosis (19.6%, 28/143) were the most-common causes. There were also one patient with Beh,cet's disease and one with congenital MAS in the cohort. Hypertension was the most -com-mon manifestation. Constitutional symptoms were mainly seen in Takayasu arteritis, and neurological, gastrointestinal and vascular symptoms were common in both Takayasu arteritis and atherosclerosis. The infrarenal segment was the most -commonly involved in atherosclerosis (89.3%, 25/28), whereas lesions were more distributed in Takayasu arteritis. The mean length of involved segments was longer (43.45 +/- 23.64 mm vs. 30.68 +/- 12.66 mm; P = 0.018) and the degree of ste-nosis was lower (80.20 +/- 13.36% vs. 87.50 +/- 13.95%, P = 0.004) in Takayasu arteritis than atherosclerosis. The most -common concurrently involved branch was the renal artery, followed by the celiac trunk and mesenteric arteries, in both Takayasu arteritis (51.8%, 32.7% and 27.3%, respectively) and atherosclerosis (53.6%, 25.0% and 17.9%, respectively). Concurrent artery involvement and coexisting lesions were absent in MAS caused by congenial coarctation of the abdomi-nal aorta and Beh,cet's disease. Conclusions: Takayasu arteritis and atherosclerosis were the most-common causes of MAS among these adults. Imaging tests provided evidence of involved segments and luminal and mural changes, aiding conclusive diagnoses and etiological dif-ferentiation of MAS. [Am J Med Sci 2023;365(5):420-428.]

ObjectiveTo examine the consistency of plasma aldosterone concentration at 1 and 2 h in the captopril challenge test (CCT) and to explore the possibility of replacing 2-h aldosterone concentration with 1-h aldosterone concentration for diagnosis of primary aldosteronism (PA).MethodsThis retrospective analysis included a total of 204 hypertensive patients suspected of having PA. Subjects received oral captopril challenge at 50 mg (25 mg if the systolic blood pressure was <120 mmHg), and plasma aldosterone concentration and direct renin concentration were measured at 1 and 2 h afterward (chemiluminescence immunoassay Liaison® DiaSorin, Italy). Sensitivity and specificity were used to reflect the diagnostic performance of 1-h aldosterone concentration using 2-h aldosterone concentration (11 ng/dl as the cutoff) as the reference. A receiver operating characteristic curve analysis was also conducted.ResultsAmong the 204 included patients [median age of 57.0 (48.0–61.0) years, 54.4% men], a diagnosis of PA was established in 94 patients. Aldosterone concentration in the patients with essential hypertension was 8.40 (interquartile range 7.05–11.00) ng/dl at 1 h and 7.65 (5.98–9.30) ng/dl at 2 h (P < 0.001). In patients with PA, aldosterone concentration was 16.80 (12.58–20.50) ng/dl at 1 h and 15.55 (12.60–20.85) ng/dl at 2 h (P > 0.999). At a cutoff of 11 ng/dl, the sensitivity and specificity of using 1-h aldosterone concentration to diagnose PA were 87.2% and 78.2%, respectively. A higher cutoff of 12.5 ng/ml increased specificity to 90.0% but decreased sensitivity to 75.5%. A lower cutoff of 9.3 ng/ml increased sensitivity to 97.9% but decreased specificity to 65.4%.ConclusionsWhen diagnosing PA with CCT, 1-h aldosterone concentration could not be used to replace 2-h aldosterone concentration.

Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China; National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China; School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China; The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu 730000, China; Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China; Lanzhou University Institute of Health Data Science, Lanzhou, Gansu 730000, China; Guideline and Standards Research Centre, Chinese Medical Association Publishing House, Beijing 100052, China; Lanzhou University GRADE Center, Lanzhou, Gansu 730000, China.

Eighteen‐hydroxycortisol (18‐OHF) is a potential biomarker for differential diagnosis of the two major primary aldosteronism subtypes, aldosterone‐producing adenoma, and idiopathic hyperaldosteronism.

目的:探讨24 h尿18-羟皮质醇(18-OHF)含量对于不同性别肾上腺醛固酮腺瘤(APA)患者的诊断价值.方法:连续入选2019年7月至2020年6月于中国医学科学院阜外医院已确诊亚型的73例原发性醛固酮增多症(原醛症)患者.收集患者一般临床资料,采用液相色谱串联质谱法检测24 h尿18-OHF含量.采用单因素Logistic回归分析明确24 h尿18-OHF含量与不同性别原醛症患者诊断APA的相关性.通过ROC曲线评价24 h尿18-OHF含量对APA的诊断价值.结果:73例原醛症患者中,女性患者30例[特发性醛固酮增多症(IAH)14例、APA 16例)],男性患者43例(IAH 11例、APA 32例).对于女性,APA患者24 h尿18-OHF含量高于IAH患者[450(260,779)nmol/d vs.220(123,276)nmol/d,P<0.05];对于男性,APA患者与IAH患者24 h尿18-OHF含量差异无统计学意义[376(242,537)nmol/d vs.251(168,384)nmol/d,P>0.05].Logistic回归分析显示,24 h尿18-OHF含量为女性和男性原醛症患者诊断APA的预测因素(P<0.01,P<0.05).ROC曲线分析显示:在女性患者中,以24 h尿18-OHF含量>298 nmol/d为诊断APA的临界值(AUC:0.74,95％CI:0.55～0.93,P<0.05),灵敏度和特异度分别为68.8％和85.7％;在男性患者中,以24 h尿18-OHF含量>205 nmol/d为诊断APA的临界值(AUC:0.67,95％CI:0.48～0.87,P>0.05),灵敏度和特异度分别为87.5％和45.5％.结论:24 h尿18-OHF含量对于女性APA诊断具有的一定价值,特异度较高.

The potential modifiable factors for remote ischemic conditioning (RIC) in reducing contrast-associated acute kidney injury (CA-AKI) in patients with acute myocardial infarction (AMI) have not been investigated. The aim of this meta-regression was to address these issues.We searched Pubmed, Embase and the Cochrane Library database for published randomized controlled trials (RCTs) with registration number CRD42020155532. Nine RCTs comprising of 1540 subjects were included in our meta-analysis. Compared with control group, RIC was associated with reduced incidence of CA-AKI [(9 studies, 1540 subjects, relative risk (RR) 0.51, 95% confidence intervals (CI) 0.35 to 0.76, p = 0.000, I-2 = 52%, p for heterogeneity 0.04)] and major adverse cardiovascular events (MACE) (5 studies, 1078 subjects, RR 0.52, 95% CI 0.38 to 0.73, p = 0.000, I-2 = 9%, p for heterogeneity 0.36) for AMI. In addition, both meta-regression and subgroup analyses have shown that RIC was more effective in the hypertensive patients in reducing CA-AKI for AMI (regression coefficient = -0.05, p = 0.021; for subgroup with more hypertensive patients: RR 0.36, 95% CI 0.25 to 0.52 vs the one with less hypertensive patients: RR 0.72, 95% CI (0.40 to 1.30, p for subgroup difference 0.008). Subsequent trial sequential analysis confirmed the effect of RIC in both CA-AKI and MACE. RIC is an effective strategy in reducing CA-AKI and MACE in patients with AMI, especially for patients with hypertension.

ObjectiveMounting evidence has linked microbiome and metabolome to systemic autoimmunity and cardiovascular diseases (CVDs). Takayasu arteritis (TAK) is a rare disease that shares features of immune‐related inflammatory diseases and CVDs, about which there is relatively limited information. This study was undertaken to characterize gut microbial dysbiosis and its crosstalk with phenotypes in TAK.MethodsTo address the discriminatory signatures, we performed shotgun sequencing of fecal metagenome across a discovery cohort (n = 97) and an independent validation cohort (n = 75) including TAK patients, healthy controls, and controls with Behçet's disease (BD). Interrogation of untargeted metabolomics and lipidomics profiling of plasma and fecal samples were also used to refine features mediating associations between microorganisms and TAK phenotypes.ResultsA combined model of bacterial species, including unclassified Escherichia, Veillonella parvula, Streptococcus parasanguinis, Dorea formicigenerans, Bifidobacterium adolescentis, Lachnospiraceae bacterium 7 1 58FAA, Escherichia coli, Streptococcus salivarius, Klebsiella pneumoniae, Bifidobacterium longum, and Lachnospiraceae Bacterium 5 1 63FAA, distinguished TAK patients from controls with areas under the curve (AUCs) of 87.8%, 85.9%, 81.1%, and 71.1% in training, test, and validation sets including healthy or BD controls, respectively. Diagnostic species were directly or indirectly (via metabolites or lipids) correlated with TAK phenotypes of vascular involvement, inflammation, discharge medication, and prognosis. External validation against publicly metagenomic studies (n = 184) on hypertension, atrial fibrillation, and healthy controls, confirmed the diagnostic accuracy of the model for TAK.ConclusionThis study first identifies the discriminatory gut microbes in TAK. Dysbiotic microbes are also linked to TAK phenotypes directly or indirectly via metabolic and lipid modules. Further explorations of the microbiome–metagenome interface in TAK subtype prediction and pathogenesis are suggested.

ObjectivePredictive value of myocardial injury as defined by elevated cardiac tropnins (cTns) in patients with COVID-19 has not been fully investigated. We performed a meta-analysis to evaluate the dose–response relationship between myocardial injury and short-term all-cause mortality.MethodsPubmed, Embase, and the Cochrane Library database were searched for all the studies which evaluated the relationship between cTns and the risk of short-term all-cause mortality in patients with COVID-19.ResultsCompared with patients without myocardial injury, the group with elevated cTns was associated with increased short-term mortality (11 studies, 29,128 subjects, OR 3.17, 95% CI 2.19–4.59, P = 0.000, I2 = 92.4%, P for heterogeneity 0.00). For the dose–response analysis, the elevation of cTns 1 × 99th percentile upper reference limit (URL) was associated with increased short-term mortality (OR 1.99, 95% CI 1.53–2.58, P = 0.000). The pooled OR of short-term mortality for each 1 × URL increment of cTns was 1.25 (95% CI 1.22–1.28, P = 0.000).ConclusionWe found a positive dose–response relationship between myocardial injury and the risk of short-term all-cause mortality, and propose elevation of cTns > 1 × 99th percentile URL was associated with the increased short-term risk of mortality.

目的:探讨卡托普利抑制试验(CCT)中给药后不同时间测定的血浆醛固酮水平(PAC)对原发性醛固酮增多症(PA)患者诊断的价值.方法:纳入2019年1月至2020年6月于中国医学科学院阜外医院高血压中心住院筛查的继发性高血压患者45例,其中男性18例(40％),女性27例(60％),平均年龄(50.60±10.33)岁.立位试验醛固酮/肾素值(ARR)≥2.4(ng/dl)/(μIU/ml),需进一步行CCT的患者共45例,根据2 h CCT法将患者分为PA组和非PA组.于给药前及给药后1 h、1.5 h及2 h抽血化验PAC、直接肾素浓度(DRC)、皮质醇(COR)水平.结果:PA组患者20例,非PA组患者25例.两组患者的PAC、ARR变化均在给药后随采血间隔时间延长呈下降趋势,DRC在给药后随采血间隔时间延长呈上升趋势(P均<0.001),这种差异主要由0～1 h的差异所产生(P均<0.05),而1～1.5 h、1.5～2 h之间的PAC、DRC、ARR变化差异均无统计学意义(P均>0.05).PAC 1 h及PAC 1.5 h截断点均为9.95 ng/dl,灵敏度分别为90％、95％,特异度分别为92％、96％,AUC分别为0.945和0.970,Kappa值分别为0.820和0.910.结论:在进行CCT过程中,给药后1 h或1.5 h测定PAC≥9.95 ng/dl,可作为PAC 2 h的代替指标对PA患者进行确诊,具有较好的拟合度及区分度,进而简化CCT流程,减少患者抽血次数.

1 病例资料 患者,女,60岁,以"胸背部疼痛5年,加重4个月"入院.患者5年前逐渐出现持重物或重体力劳动后胸骨后、背部疼痛,每次持续数小时至数天不等,自行缓解,当地医院检查未见异常.4个月前疼痛症状加重,呈撕裂样,不能耐受.

Objective: Evidence-based studies on endovascular approaches for childhood Takayasu arteritis(c-TA) are limited. This study presented the real-world scenario of largest cohort up-to-date for c-TA patients undergoing interventions and their post-interventional outcomes. Design and method: Patients with c-TA satisfying the 1990 ACR or 2010 EULAR/PRINTO/PReS criteria were recruited from January 2002 to December 2017. Data on clinical, laboratory, imaging features, treatment and post-interventional outcomes were collected. Statistical analysis was performed based on data distribution. Complication-free survival and Re-intervention-free survival were projected by Kaplan-Meier methods and compared by Log-rank tests. Associated factors for intervention (or stenting) and predictors for post-interventional complications (or re-interventions) were assessed via Logistic regression and COX regression models, respectively. Results: Among 101 patients enrolled, 69(68.3%) underwent 121 interventions (Angioplasty 95; Stenting 26) during a median 3.1 years of follow-up. Compared with the medical treatment group, the intervention group appeared with fewer male population(18.8% vs 39.3%, OR = 0.2, p = 0.017) and more type IV disease(47.8% vs. 17.9%, OR = 10.60, p = 0.002). Male sex also indicated the risk for re-intervention(HR = 4.72, p = 0.016). Retinopathy(OR = 4.8, p = 0.027), time of delay in diagnosis per year(OR = 1.76, p = 0.016) and descending thoracic aorta involvement(OR = 10.19, p = 0.003) associated with stent insertion. Hypertension secondary to renal artery(59.4%) or mid-aorta(14.5%) stenosis, heart failure(21.7%), claudication(21.7%) served as leading clinical hints for interventions. Anti-inflammatory and anti-platelet therapies covered 89.9% and 91.3% patients, respectively. The technical success rate was 96.7%. Over median 2.88 years since intervention, 36 lesions occurred complications in 28 patients and 22 lesions in 17 patients, majorly on renal artery or mid-aorta. The 5-year complication-free and re-intervention survivals were 50.7% and 65.8%, separately. Dual antiplatelet therapy(HR = 0.28, p = 0.011), concurrent surgery(HR = 14.84, p = 0.002), retinopathy secondary to hypertension(HR = 3.54, p = 0.004), and pulmonary artery hypertension(HR = 3.0, p = 0.024) were independent predictors for complications. Conclusions: Over two-thirds c-TA patients require interventions and the 5-year complication-free survival is 50.7%. Male sex, retinopathy, and pulmonary artery hypertension alert unfavorable outcomes. Dual anti-platelet therapy appears to protect c-TA patients from post-interventional complications. Endovascular approaches can be a choice for mid-aorta and/or renal artery lesions caused by c-TA.

Objective To analyze the causes of renal artery stenosis (RAS) and compare the clinical characteristics in accordance with the primary disease among patients aged from 30 to 50. Methods Patients were grouped by etiologies of RAS. Groups were retrospectively examined and compared regarding demographic data, clinical manifestations, laboratory findings, and imaging findings. Results A total of 152 patients (74 females, 78 males; mean age: 40.70 ± 6.01 years) were enrolled, including 84 patients (55.3%) with atherosclerosis (AS), 46 patients (30.3%) with Takayasu arteritis (TA), 18 patients (11.8%) with fibromuscular dysplasia (FMD), and four patients (2.6%) with other etiologies. Patients in AS group had greater body mass index, higher prevalence of comorbidities and higher rate of smoking and drinking history. TA patients showed more constitutional symptoms and vascular findings, and higher erythrocyte sedimentation rate. RAS in both AS group and TA group mainly located on ostia and proximal segments, but RAS in FMD group mainly involved middle to distal segment of renal artery. The AS group had significantly lesser stenosis than the other groups. Although renal function evaluated by the estimated glomerular filtration rate did not significantly differ among the groups, the incidence of kidney shrinkage was significantly higher in the TA and FMD groups (39.1% and 50%, respectively) than in the AS group (8.3%). The FMD group had milder cardiac damage than other groups. Conclusions AS was the most common cause of RAS in patients aged from 30 to 50, followed by TA and FMD. The etiology of RAS should be carefully distinguished based on clinical manifestations, laboratory findings, and imaging to ensure that proper treatment is provided.