[Change of blood pressure and pulse rate in intravenous urography]

We monitored the blood pressure and pulse rate during routine excretory urography in 3002 patients (4832 examinations) using high osmolality contrast medium. After injection of contrast medium, the blood pressure was changed more than 20% of the pre-injection blood pressure lasting for more than 1 minute in 27 patients (27 examinations, 0.56%), including 8 patients with a hypertensive reaction (0.17%) and 19 patients with a hypotensive reaction (0.39%). In all 27 patients, transient tachycardia was seen along with the progress of blood pressure change. Bradycardia was associated with a severe hypotensive reaction in 2 patients. In 19 patients with a hypotensive reaction, the blood pressure was progressively decreased beyond 60 mmHg in 9 patients (0.18%) while the blood pressure was remained above 60 mmHg in 10 patients (0.21%). Treatment was not necessary in 8 patients with a hypertensive reaction as well as in 10 patients with a mild hypotensive reaction (above 80 mmHg). In these 18 patients, the examination would have been finished without a suspicion of the blood pressure change unless the blood pressure was monitored. In 9 patients with a severe hypotensive reaction (below 60 mmHg), the subjective or objective symptoms were present during the examination in 7 patients. They should be considered to have had "severe adverse reaction". In remaining 2 patients, there was no subjective or objective symptoms. We discussed possible mechanisms regarding the change of blood pressure and pulse rate after injection of contrast medium.