Impact of Mental Health on Blood Pressure Nonresponse Following Renal Artery Stenting: A Prospective Cohort Study (Preprint)
Authors: Li Li Peng 
Published: October 2024

BACKGROUND

Renal artery stenosis (RAS) is a significant cause of secondary hypertension, often requiring percutaneous transluminal renal artery stenting. However, patient outcomes, particularly in terms of blood pressure (BP) response and mental health status, can vary widely post-intervention. The impact of these variables on anxiety and depression in this population remains underexplored.

OBJECTIVE

This study aimed to evaluate the factors associated with BP nonresponse and the development of anxiety and depression following renal artery stenting in patients with severe unilateral RAS

METHODS

A prospective cohort study was conducted at Beijing Hospital between October 2017 and December 2020. A total of 164 patients who underwent successful renal artery stenting were included. Patients were divided into BP response (n = 98) and BP nonresponse groups (n = 66) based on BP measurements at 12 months post-procedure. Clinical data, including demographic information, comorbidities, renal function, NT-proBNP levels, antihypertensive medications, and psychological status (using the Self-Rating Anxiety Scale and Self-Rating Depression Scale), were collected at baseline and at the 12-month follow-up. Multivariate logistic regression was performed to identify factors associated with BP nonresponse, anxiety, and depression.

RESULTS

Compared to the BP response group, the BP nonresponse group had a higher proportion of current smokers (63.6% vs. 42.9%, P=0.009), more comorbidities (≥3) (66.7% vs. 40.8%, P=0.001), lower eGFR (50.7 ± 15.7 vs. 56.7 ± 13.9 mL/min/1.73 m², P=0.011), higher NT-proBNP levels (379.2 ± 203.1 vs. 327.4 ± 154.9 pg/mL, P=0.033), and more frequent use of ≥4 types of antihypertensive medications (75.8% vs. 58.2%, P=0.021). Multivariate analysis revealed that lower eGFR (OR=0.924, 95% CI: 0.883–0.966, P<0.001), higher NT-proBNP (OR=1.309, 95% CI: 1.075–1.595, P=0.008), higher SAS scores at 12 months (OR=1.102, 95% CI: 1.013–1.199, P=0.025), and use of ≥4 antihypertensive medications (OR=1.785, 95% CI: 1.114–2.861, P=0.016) were independent predictors of BP nonresponse. Anxiety was associated with younger age (OR=0.951, 95% CI: 0.914–0.989, P=0.009), lower education level (OR=1.357, 95% CI: 1.108–1.661, P=0.001), higher degree of RAS (OR=2.253, 95% CI: 1.249–4.063, P=0.002), and BP nonresponse (OR=1.629, 95% CI: 1.137–2.334, P=0.003). Depression was more common in women (OR=1.163, 95% CI: 1.038–1.303, P=0.010), unmarried individuals (OR=1.140, 95% CI: 1.068–1.217, P<0.001), those with lower education (OR=1.205, 95% CI: 1.061–1.368, P=0.009), and those with BP nonresponse (OR=1.316, 95% CI: 1.105–1.568, P=0.008).

CONCLUSIONS

BP nonresponse following renal artery stenting was associated with lower renal function, elevated NT-proBNP levels, and increased psychological distress, particularly anxiety and depression. These findings highlight the need for targeted interventions in high-risk patients to improve both clinical and mental health outcomes post-stenting.

CLINICALTRIAL

This study was registered in the China Clinical Trial Registration Center (ChiCTR1800016252) and approved by the Institutional Review Board (IRB) of Beijing Hospital (No. 2018BJYYEC-043-02).