Management of Resistant Hypertension in Patients with Carotid Stenosis: High Prevalence of Renovascular Hypertension
Bibliographic record
Abstract
INTRODUCTION: Patients with carotid stenosis are at high risk of vascular events and therefore require an optimal control of risk factors such as hypertension. As the treatment of hypertension differs according to the cause, we examined the prevalence of resistant hypertension, and the cause of hypertension, among patients with carotid stenosis followed closely in two randomized trials of carotid endarterectomy. OBJECTIVE: The purpose of this study was to determine the prevalence of resistant hypertension and of secondary hypertension among patients with carotid stenosis. METHODS: A chart review was performed of all patients from our center who participated in the North American Symptomatic Carotid Endarterectomy Trial or the Asymptomatic Carotid Artery Study to determine the prevalence of renovascular hypertension. RESULTS: Among 170 patients with carotid stenosis followed in these two trials, 145 (83.5%) were hypertensive (systolic >160 or diastolic >90 mm Hg); at least 24 (14.1% overall, 16.6% of hypertensives) had renovascular hypertension based on either nuclear medicine renography, renal angiography or both; among the 79 patients with resistant hypertension (mean arterial pressure >130 mm Hg despite treatment), 20 (25.3%) had renovascular hypertension. Adrenocortical hyperplasia was the underlying cause of hypertension in 12 (7.1% of cases, 8.3% of hypertensives, 8.8% of resistant hypertensives). Blood pressures were significantly higher for patients with renovascular and adrenocortical hypertension (p < 0.0001 for systolic, p = 0.024 for diastolic pressures). CONCLUSION: Among patients with carotid stenosis, renovascular hypertension is unusually common. Resistant hypertension among such patients should lead to investigation and management directed at the cause of hypertension. Appropriate investigations might include plasma renin/aldosterone ratio, captopril renography and MRA of the renal arteries or renal angiography.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".