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  • JSH2025 Systematic Review Series: Clinical Questions in the Management of Hypertension
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Combination of medical therapy and percutaneous transluminal renal angioplasty versus medical therapy alone for patients with atherosclerotic renal artery stenosis: systematic review and meta-analysis

Hypertension Research volume 48, pages 1870–1879 (2025)Cite this article

Abstract

We investigated whether the combination of medical therapy plus percutaneous transluminal renal angioplasty (PTRA) provides superior clinical outcomes compared to those afforded by medical therapy alone in patients with hypertension due to atherosclerotic renal artery stenosis (ARAS) by conducting a systematic review and meta-analysis of the relevant randomized controlled trials (RCTs). The evaluated outcomes included: (1) cardiovascular disease (CVD)-related mortality, (2) the incidence of CVD events, (3) changes in blood pressure (BP), (4) suppression of renal function decline, (5) changes in the number of antihypertensive drugs used, and (6) serious adverse events. Nine RCTs involving 2275 patients were analyzed, revealing that the combination therapy significantly reduced the number of antihypertensive drugs compared to medical therapy alone (mean difference: –0.42, 95% confidence interval: –0.71 to –0.12). However, there were no significant differences between the combination therapy and medical therapy alone in CVD mortality, the incidence of CVD events, BP changes, suppression of renal function decline, or serious adverse events. The included studies demonstrated a low-to-moderate risk of bias, with performance and detection bias being the most prominent concerns. Together our findings demonstrate that compared to medical therapy alone, the combination of medical therapy + PTRA reduced the number of antihypertensive drugs used but did not improve adverse CVD or renal outcomes. The quality of the included RCTs represents a potential limitation of this analysis.

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Acknowledgements

This study was supported by the Japanese Society of Hypertension guideline committee. We would like to acknowledge Dr. Hisatomi Arima for providing valuable guidance in structuring the manuscript to align with the requirements of a systematic review and meta-analysis.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan

    Takeshi Fujiwara & Keisuke Narita

  2. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoshio Iwashima

  3. Columbia Hypertension Laboratory, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Keisuke Narita

  4. Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan

    Michihiro Satoh

  5. Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan

    Michihiro Satoh

  6. Health Administration Center, University of the Ryukyus, Okinawa, Japan

    Atsushi Sakima

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  1. Takeshi Fujiwara
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  2. Yoshio Iwashima
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  3. Keisuke Narita
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  4. Michihiro Satoh
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Correspondence to Takeshi Fujiwara.

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Fujiwara, T., Iwashima, Y., Narita, K. et al. Combination of medical therapy and percutaneous transluminal renal angioplasty versus medical therapy alone for patients with atherosclerotic renal artery stenosis: systematic review and meta-analysis. Hypertens Res 48, 1870–1879 (2025). https://doi.org/10.1038/s41440-025-02166-3

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  • DOI: https://doi.org/10.1038/s41440-025-02166-3

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