Outcomes of renal angioplasty for fibromuscular dysplasia in Asian vs. white patients: a systematic review and meta-analysis.

Percutaneous transluminal renal angioplasty (PTRA) is the first-line treatment for fibromuscular dysplasia (FMD)-related renal artery stenosis. Previous meta-analyses were predominantly based on white populations. We updated the meta-analysis to include Asian data and allow ethnicity-specific comparisons. Seven databases were systematically searched for clinical studies published since 2000 reporting PTRA outcomes in FMD. Data were pooled using random-effects models. Twenty-nine studies (1470 patients) were included: 15 Asian ( n  = 823) and 14 white ( n  = 647). Hypertension cure was significantly higher in Asians (40 vs. 17%; P  < 0.001). Cure or improvement tended to be higher in Asians (90 vs. 78%; P  = 0.08). SBP reduction tended to be greater (-33 vs. -23mmHg; P  = 0.08), and DBP reduction was significantly greater in Asians (-21 vs. -11 mmHg; P  = 0.016). Reduction in antihypertensive drugs (-1.1 vs. -0.8; P  = 0.10), technical success (97 vs. 99%; P  = 0.25), and restenosis (20 vs. 19%; P  = 0.96) were similar. Overall reported periprocedural complications were more frequent in whites (12 vs. 1%; P  = 0.01), with no deaths in either group. In meta-regression, younger age and a higher proportion of men were associated with hypertension cure in univariable analyses. However, when both variables were included in a multivariable model, only age remained independently predictive. PTRA shows comparable safety and procedural success in Asian and white patients with renal FMD, while BP responses are more favorable in Asians. Age independently predicts hypertension cure, underscoring the importance of early diagnosis and timely intervention.