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[Treatment of hypertension in arteritic patients]
1Service d'Hypertension Artérielle et de Médecine Vasculaire, Hôpital Saint-Joseph, Paris.
Insights
Treating hypertension in arteritic patients requires careful consideration of atherosclerosis severity and causes. Non-drug therapies and specific antihypertensives like calcium channel blockers are preferred, while beta-blockers may worsen claudication.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Context:
- Hypertension management in patients with arteriopathy presents unique challenges.
- Concurrent atherosclerosis requires tailored treatment strategies.
- Renal artery stenosis is a critical consideration in hypertensive arteritic individuals.
Purpose:
- To outline optimal hypertension treatment strategies for arteritic patients.
- To highlight the risks and benefits of various antihypertensive agents in this population.
- To emphasize the importance of identifying renal artery stenosis before initiating certain therapies.
Summary:
- Treatment decisions for hypertension in arteritic patients depend on the severity of both conditions and potential atherosclerotic complications.
- Non-pharmacological interventions and specific drug classes like calcium channel blockers are recommended.
- Beta-blockers may negatively impact walking distance, while ACE inhibitors require careful screening for renal artery stenosis due to risks of renal failure.
Impact:
- Provides guidance for clinicians managing complex hypertensive patients with vascular disease.
- Informs treatment choices to optimize blood pressure control and preserve peripheral circulation.
- Highlights the need for diagnostic vigilance regarding renal artery stenosis in atherosclerotic patients.
Abstract:
The treatment of hypertension in arteritic patients must take account of several parameters: respective severity of hypertension and of arteriopathy, possibility of other sites of atherosclerosis and supposed cause of hypertension. The association of essential hypertension and of an arteriopathy does not sum up all possibilities. Hypertension may be purely systolic, due to decreased compliance. A stenosis of the renal arteries is also worth evoking in the context of an already symptomatic atherosclerotic disease. For the confirmation of the latter hypothesis, Doppler associated to echography may be an alternative to the intravenous or intra-arterial opacification of the renal arteries. In case of moderate hypertension (diastolic pressure ranging from 90 to 104 mmHg), non-medicamentous treatments should be preferred: low-sodium diet, suppression of tobacco and other risk factors, weight loss. Beta-blockers, whatever their class, reduce the walking distance in case of intermittent claudication. Though not formally contraindicated, especially when their use is justified by an associated coronary insufficiency, they are not advised in hypertensive arteritic patients. On the other hand, captopril allows both reducing blood pressure and preserving the walking distance. However, a prerequisite to the possible use of agents inhibiting the conversion enzyme is the preliminary search for a stenosis of the renal arteries. In fact, when these medications are carelessly used in case of bilateral stenosis or of stenosis on a functionally single kidney, they entail a risk of renal failure or of thrombosis of the stenosed renal artery. Calcium inhibiting agents are also anti-hypertensive substances of choice in hypertensive arteritic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)