Nomogram for Predicting Postoperative Blood Pressure Reduction in Hypertensive Patients: A Single-Center Retrospective Study.

Background

Hypertension is a major public health problem. In clinical practice, we have observed that when hypertensive patients undergo robotic-assisted partial nephrectomy (RAPN), approximately half of them experience a normalization of their blood pressure (BP) shortly after the surgery. This study aims to investigate the effect of RAPN on BP in hypertensive patients with renal tumor by disassociating nerve tissue around the renal artery.

Methods

We reviewed patients with renal tumor requiring RAPN who were admitted to our department from January 2021 to January 2024, with a minimum follow-up of 3 months. A total of 260 hypertensive patients combined with renal tumor were followed up. Univariate and multivariate logistic regression analyses were sequentially employed to determine the factors associated with blood pressure normalization following RAPN. Finally, a nomogram model based on independent risk factors was established and validated.

Results

A total of 55.38% (144/260) hypertensive patients combined with renal tumor have achieved blood pressure normalization following RAPN. A multivariate logistic regression analysis showed that preoperative BP (OR=0.145; 95%CI:0.052-0.421; p<0.001), circulatory diseases(OR=15.661; 95%CI:8.611-30.576; p<0.001), plasma renin activity ratio(PRA) (OR=0.071; 95%CI:0.035-0.131; p<0.001), preoperative angiotensin II (AT II) (OR=0.693; 95%CI:0.551-0.861; p=0.002), Body Mass Index (BMI) (OR=0.526; 95%CI:0.355-0.713; p=0.031) were independently correlated with blood pressure normalization. We constructed a nomogram prediction model based on these independent risk factors. Validation through receiver operating characteristic curve, calibration curves, and decision curve analysis demonstrated a strong correlation between predicted and actual occurrence probabilities.

Conclusion

This procedure blocks the renin-angiotensin-aldosterone system by disassociating nerve tissue around the renal artery in hypertensive patients, thereby reducing their BP. This surgical method may become a potential new treatment for hypertension in the future.