Results of surgery in hypertension due to renal artery stenosis

American Journal of Medicine, 1964

Annals of Surgery, 1966

Japanese Heart Journal, 1969

Hypertension Journal, 2016

Hypertension is one of the most important risk factors for mortality and morbidity globally. It is the most common chronic cardiovascular disease that results in increased hospital admissions worldwide. As hypertension has a long list of primary as well as secondary causes, hypertension induced by renal artery stenosis (RAS) is a form of secondary hypertension caused by renin overproduction and it affects approximately 2 to 5% of hypertensive patients. We report a case of RAS as a cause of resistant hypertension. It is important to make a note that resistant hypertension is the blood pressure above a goal despite adherence to at least three optimally dosed antihypertensive medications of different classes, one of which is a diuretic. Besides, there are other categories of resistant hypertension or difficult-to-treat hypertension such as primary hyperaldosteronism, thyrotoxicosis, chronic kidney disease, drug-drug interactions as well steroids, nonsteroidal anti-inflammatory drugs, erythropoietin, and herbal preparations such as liquorice. Morbid obesity is also associated with resistant hypertension.

Southern Medical Journal, 1970

Renovasküler hipertansiyon, sekonder hipertansiyonun en yaygın nedenlerinden biridir. Renovasküler hipertansiyon, çocukluk çağı hipertansiyonunun% 5-10'una neden olur. Renal arter darlığı, renovasküler hipertansiyonun en önemli nedenidir. Renovasküler hipertansiyonu olan hastalar asemptomatik olabilir veya baş ağrısı, kusma, konvülsiyon, kalp hastalığı ve ani ölüm gibi birçok semptomla başvurabilirler. Renovasküler hipertansiyonda medikal tedaviye cevap vermeyen şiddetli yüksek tansiyonda cerrahi tedavi gerekebilir. Bu çalışmada anjiyotensin II reseptör blokerleri ile kontrol edilen bilateral renal arter stenozuna bağlı renovasküler hipertansiyon gelişen dört aylık bir bebeği sunuyoruz. Anahtar Kelimeler: Anjiyotensin II reseptör blokerleri, renal arter stenozu, renovasküler hipertansiyon, tedavi Renovascular hypertension is one of the most common causes of secondary hypertension. Renovascular hypertension causes 5-10% of childhood hypertension. Renal artery stenosis is the most important cause of renovascular hypertension. Patients with renovascular hypertension may be asymptomatic or present with many symptoms such as headache, vomiting, convulsion, heart disease, and sudden death. In renovascular hypertension, surgical treatment may be required in severe high blood pressure that does not respond to medical treatment. In this study, we present a four-month-old infant who developed renovascular hypertension due to bilateral renal artery stenosis, which was controlled by angiotensin II receptor blockers.

The American Journal of Surgery, 1953

Medical Journal of Indonesia, 2014

Abstrak Hipertensi sekunder jarang terjadi, namun harus menjadi kecurigaan pada pasien usia muda. Hipertensi sekunder harus didiagnosis dan ditatalaksana secara tepat. Stenosis arteri renalis merupakan salah satu penyebab hipertensi sekunder. Tujuan dari laporan kasus ini adalah menjelaskan diagnosis, patofisiologi dan tata laksana hipertensi sekunder akibat stenosis arteri renalis pada usia muda. Seorang pria berusia 17 tahun dengan gejala sesak nafas didiagnosis menderita hipertensi tahap 3 pada pemeriksaan rutin di Rumah Sakit Pasar Rebo, Jakarta. CT scan abdomen menunjukkan stenosis arteri renalis bilateral. Prosedur invasif PTA (Percutaneous Transluminal Angiography) arteri renalis kiri dilakukan di Pusat Jantung Nasional Harapan Kita dan satu stent dipasang dengan hasil baik. Tekanan darah setelah pemasangan stent normal.

Baylor University Medical Center Proceedings

Circulation, 2005

T he major issues in approaching patients with renal artery stenosis relate to the role of renal artery stenosis in the management of hypertension, ie, "renovascular hypertension," and to the potential for vascular compromise of renal function, ie, "ischemic nephropathy." Ever since the original Goldblatt experiment in 1934, wherein experimental hypertension was produced by renal artery clamping, countless investigators and clinicians have been intrigued by the relationship between renal artery stenosis and hypertension. Much discussion has focused on the pathophysiology of renovascular hypertension, the renin angiotensin system, diagnostic tests to detect presumed renovascular hypertension, and the relative merits of surgical renal revascularization (SR), percutaneous transluminal renal angioplasty (PTRA), and drug therapy in managing patients with renal artery stenosis and hypertension. Hemodynamically significant renal artery stenosis, when bilateral or affecting the artery to a solitary functioning kidney, can also lead to a reduction in kidney function (ischemic nephropathy). This untoward observation may be reversed by interventive maneuvers, eg, surgical renal revascularization, PTRA, or renal artery stenting. The syndrome of "ischemic renal disease" or "ischemic nephropathy" now looms as an important clinical condition and has attracted the fascination of nephrologists, vascular surgeons, and interventional cardiologists and radiologists.

Acta Radiologica, 1989

Hypertension constitutes a major health problem and the challenge is to identify patients having 'surgically' curable renal vascular disease among the majority with so-called essential hypertension. The best of unsatisfactory diagnostic tests are renography and plasma renin activity both before and during angiotensin I1 blockade. The necessity of better screening tests has increased because of the recent advances in surgical techniques and especially percutaneous transluminal renal angioplasty. The latter has definitely become the method of choice for correction of suspected hemodynamically significant artery stenoses whenever technically feasible. With improved angioplasty techniques the risk of treating renal artery stenosis without hemodynamic and clinical importance (so-called cosmetic repair) has increased. Unfortunately randomized trials including surgery versus angioplasty are not available. It should be kept in mind that only after correction of the stenosis is achieved and the blood pressure has become normal, can the diagnosis of renovascular hypertension be made with certainty.

Archives of Disease in Childhood, 1999

Journal of Pediatric Surgery, 1970

The American Journal of Cardiology, 2013

The aim of the study was to assess the significance of renal translesional pressure gradients in predicting improvement in resistant hypertension after stenting for moderate renal artery stenosis (RAS). In 37 patients with RAS and resistant hypertension subjected to renal stenting, translesional pressure gradients both at rest and hyperemic were measured using a pressure guidewire. Twenty-four-hour ambulatory blood pressure measurements were performed in all patients on admission and 3 months after the intervention. Angioplasty was successful in all patients, with reduction of artery diameter stenosis from 60 -12% to 10 -6% (p <0.0001). At 3 months, with maintained hypotensive agents (4.0 -1.4 vs 4.0 -1.6), significant reductions in systolic blood pressure (SBP) and diastolic blood pressure were noted (L5 and L2 mm Hg, respectively). In multivariate analysis, the mean baseline gradient (MBG) was the only independent predictor of improvement in SBP (regression coefficient 0.292; standard error 0.11; p value 0.014). In the receiver operating characteristic curve analysis, MBG had a larger area under the curve than other parameters, and the MBG >22 mm Hg had the highest sensitivity, specificity, and accuracy (50%, 95%, and 0.74%, respectively) in predicting hypertension improvement after stenting. In patients with MBG >22 mm Hg, SBP decreased by 12 versus 3 mm Hg (p <0.01) in patients with MBG £22 mm Hg, whereas diastolic blood pressure in both groups decreased by 3 versus 1 mm Hg, respectively (NS). In conclusion, MBG value of >22 mm Hg provides the highest accuracy in predicting hypertension improvement after stenting for moderate RAS in patients with resistant hypertension. Ó 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;112:1417e1420)

Journal of clinical hypertension (Greenwich, Conn.), 2010

Journal of the Royal Society of Medicine, 1984