Renovascular hypertension usually affects women under 30 and men over 50. What is the cause of this disease? Find out about renovascular hypertension and how to treat it.

Renovascular hypertensionis a special type of arterial hypertension. This is calledsecondary hypertension , which occurs in about 10 percent of patients with increased blood pressure, and it results from the narrowing of the renal artery, which in turn may be a consequence of vascular malformations, as well as various diseases of the kidneys, renal arteries and adrenal glands. When diagnosed in a timely manner, renovascular hypertension is relatively easy to cure.

The role of the kidneys in regulating blood pressure

Properly functioning kidneys play an important role in regulating blood pressure. It happens mainly through their influence on the sodium economy of the system. When sodium levels drop, such as during sleep, and blood pressure drops, the kidneys secrete a substance called renin into the blood.

Over 80% of people with renovascular hypertension admit that they smoke cigarettes.

Renin starts a chain of reactions that ends with angiotensin II. Its task is to narrow the small arteries, thus increasing blood pressure to the correct level. When this happens, renin is stopped being secreted. However, when the kidneys are failing or damaged (for example, from frequent infections, glomerulitis, or long-term untreated high blood pressure), they continuously produce renin. The constant high level of this substance in the blood leads to the development of chronic hypertension. Another, and the most common reason why the kidneys produce too much renin - causing high blood pressure - is narrowing of the renal artery.

Why is the lumen of the renal artery narrowing?

Usually (even in 90% of patients) it is about the build-up of atherosclerotic plaque (diet and cigarettes!), Which is usually located near the branch of the renal artery (or both) from the aorta and clogs it in at least 75 percentages (if the atherosclerosis is not so advanced, the cause of hypertension does not have to be stenosis). Atherosclerotic changes usually occur in patients with hypertension after the age of 50 and often coexist withatherosclerosis of the aorta, carotid, intracerebral, coronary or lower extremities. Other causes of renal artery stenosis include arterial dysplasia, which is a morbid fibromuscular growth of the arterial walls, glomerulitis, and Takayasu's disease.

Renovascular hypertension: symptoms

Renovascular hypertension is most often diagnosed when the first episodes of hypertension occur before the age of 30 (mainly in women) or after 50 (especially in men), and when suddenly previously well-treated hypertension becomes troublesome until composure. However, unfortunately, this type of hypertension is not easy to diagnose, and certainly not by a basic medical examination. Most of the symptoms are simply the same as those of primary hypertension. However, the doctor's attention should be drawn to:

  • occurrence of hypertension before 30 or after 50 years of age
  • refractory hypertension in patients receiving the correct combination of three antihypertensive drugs
  • development of renal failure after administration of ACE inhibitors or angiotensin II receptor antagonists.
  • sudden deterioration of previously well-controlled hypertension
  • general symptoms of atherosclerosis
  • epigastric murmur
  • recurrent pulmonary edema
  • asymmetry of kidney size (over 1.5 cm)
  • low blood potassium levels
  • hypokalemia
  • alkalosis
  • deteriorating kidney function

Renovascular hypertension: diagnosis

We conduct a number of diagnostic tests to detect renovascular hypertension. The procedure is more or less so that if, after one month of treatment with a calcium antagonist (e.g. amlodipine) with a beta-adrenergic blocker (e.g. atenolol) and a diuretic (e.g. indapamide), blood pressure is not stabilized, the patient should undergo further, in-depth diagnosis. towards renovascular hypertension.

The test that is helpful in the diagnosis of the disease in question is duplex-Doppler, i.e. ultrasound with the possibility of assessing blood flow in a selected place of the arterial and venous vessel. Your doctor may also recommend a CT scan or MRI. On the other hand, the best examination - albeit invasive - is angiography of the kidney vessels (renewasography).

Treatment of renovascular hypertension

There are three treatments for renovascular hypertension:

  • percutaneous balloon angioplasty combined with stenting
  • surgical correction of a narrowed renal artery
  • drug treatment

Patients who are waiting for surgery or who cannot undergo surgery are treated pharmacologically as standard. As in the treatment of essential hypertension, angiotensin converting enzyme inhibitors, calcium channel blockers and beta-adrenergic blockers are given. However, the use of an angiotensin converting enzyme inhibitor does not apply to patients with TSN of both or only kidneys, as it may cause acute renal failure.

Surgical treatment consists in the transplantation of a fragment of the artery, surgical widening or restoration of the artery. However, when it comes to surgery, it is important to know the cause of the narrowing of the artery first. For example, if it is caused by fibromuscular dysplasia, percutaneous angioplasty will provide better results. It involves the insertion of a special balloon through the femoral artery to open it, and then a stent that keeps the artery in a dilated state.

In atherosclerosis, this method is effective when the stenosis affects the main stem and is not located at the exit of the renal artery from the aorta. In other cases, it happens that the plaque returns.

Category:

Cardiology