Medical therapy versus angioplasty in atherosclerotic renal artery stenosis: A meta-analysis of randomised controlled trials .

Title: Medical therapy versus Angioplasty in Atherosclerotic Renal Artery Stenosis: A meta-analysis of Randomised Controlled Trials Background: Renal artery stenosis (RAS) can cause both renovascular hypertension reversible with renal revascularization, and renal insufficiency. Treatment of RAS by surgery or balloon angioplasty aims at avoiding lifelong antihypertensive treatment and progressive renal ischemia. Objectives: A meta-analysis will be undertaken to assess the relevant literature and to establish the comparative effectiveness of percutaneous angioplasty and medical therapy in controlling hypertension and progression of renal disease in atherosclerotic RAS. Data Sources: The English-language medical literature identified by MEDLINE search, cross-references and manual search. Study Selection: All randomised controlled trials that compared percutaneous angioplasty or interventional angioplasty or interventional angioplasty with medical therapy with at least 6 months of planned follow-up on treatment of atherosclerotic RAS were selected. Studies on fibromuscular dysplasia as cause of RAS were excluded. A total of 210 patients in 3 studies were included. Data Extraction: Data on mean level of blood pressure, mean level of renal function (serum creatinine and creatinine clearance) and number of antihypertensive drugs or median number of defined daily closes were extracted. Data Synthesis: Among 210 patients included in the study, 106 were assigned in the medical group and 104 patients in the angioplasty group. There was no significant differences between medical therapy and angioplasty in terms of mean level of systolic BP (Weighted Mean Difference (WMD)-0.12[-5.1 to 4.9,95 percent Confidence Interval (Cl)]),diastolic BP (WMD- 0.35[-3.3 to 2.6,95 percent C1 ], mean level of creatinine (WMD -0.43[-0.27 to 0.18,95 percent C1] and mean level of creatinine clearance (WMD -5.8 [-5.8 to 2.04, 95 percent C1]). There is less number of anti-hypertensive drugs and median number of defined daily doses in the angioplasty group, p value