Opening blocked kidney arteries no better than medication alone

Opening narrowed arteries to the kidney didn't help patients any more than taking medicine alone, according to a late-breaking clinical trial presented at the American Heart Association's Scientific Sessions 2013.

In the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, 947 patients with renal artery stenosis, in the setting of chronic kidney diseases or high blood pressure were randomly assigned to receive standard combination medical therapy for blood pressure, cholesterol and drugs to prevent blood clotting alone, or these medications combined with a vessel-opening procedure.

The rate of death and other serious complications, including heart attack, stroke, or hospitalization for heart or kidney disease, was comparable between treatment methods. Complications occurred in 35.8 percent of the medication-only group, and in 35.1 percent of the combined-treatment group, not a significant difference.

Renal artery stenosis, which affects nearly three million people in the United States, can cause high blood pressure and kidney failure, and is associated with heart and blood-vessel disease and death.

Standard treatment includes medication to decrease high blood pressure and cholesterol, combined with a procedure in which a small balloon is inserted into the clogged blood vessel and inflated to open it. A small, wire-mesh tube (stent) often is inserted to help keep the vessel open.

"Stenting of atherosclerotic renal stenosis has been reasonable, despite several negative studies, because other studies suggested it might lower blood pressure and stabilize kidney function," said Christopher J. Cooper, M.D., the study's lead author and professor and chairman of the Department of Medicine at the University of Toledo, Ohio. "But in our study, opening narrowed kidney arteries with stents provided no additional benefit when added to medications that lower blood pressure, control cholesterol levels and block substances involved in blood clotting."

Provided by American Heart Association