Renovascular hypertension

Renovascular hypertension is secondary hypertension caused by occlusal disease, the main renal arteries or their branches.

The cause of

The causes of renovascular hypertension are numerous, but 90 to 95% consists of two major lesions: atherosclerosis and fibromuscular dysplasia. Less common causes are aortoarteritis, traumatic aneurysms, defects in the development of renal arteries, compression of cysts, tumors or hematoma, embolism or thrombosis of the renal arteries.

The clinical picture

Patients with renovascular hypertension compared with patients with essential hypertension have a shorter duration of hypertension, poor family history and severe retinopathy. Clinical features that distinguish patients with renovascular hypertension are: severe hypertension - diastolic blood pressure greater than 115 mmHg; unexpected hypertension - occurs before puberty or after fifty years of age or is of short duration with rapid progression from mild to severe, cardiovascular disease - a disease coronary artery disease, myocardial infarction, stroke or peripheral vascular disease, resistant hypertension - insensitive to standard treatment and noise in the upper abdomen.

Diagnosis

It is based on history, clinical presentation, laboratory findings, objective examination, excretory urography, radiorenograma, angiography, renal angiography.

Treatment

Conservative treatment involves pathogenetic therapy of the underlying disease (atherosclerosis, aortoarteritis etc.) and treatment of hypertensive syndrome (antihypertensives). When the operation is possible and where it can be done, it must be done, especially in younger patients (percutaneous transluminal angioplasty, reconstructive surgery).

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