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[Etiology and prognosis of renovascular hypertension]
Insights
Surgical intervention for renovascular hypertension showed positive outcomes, with most patients experiencing normalized or improved blood pressure post-operation. However, long-term prognosis varied, particularly for atherosclerosis patients, suggesting careful consideration of treatment options.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Surgical Innovation
Context:
- Renovascular hypertension presents complex treatment challenges.
- A decade of clinical experience provides valuable insights into etiology and prognosis.
- Surgical interventions aim to restore renal blood flow and manage hypertension.
Purpose:
- To summarize the etiology and prognosis of renovascular hypertension.
- To evaluate the outcomes of surgical treatments for renovascular hypertension.
- To inform clinical decision-making regarding surgical versus conservative therapy.
Summary:
- Eleven cases of renovascular hypertension were treated, with causes including atherosclerosis, fibromuscular dysplasia, and aortitis syndrome.
- Ten patients underwent surgery (nephrectomy or reconstructive procedures), resulting in blood pressure normalization or improvement in most cases.
- Long-term follow-up indicated better outcomes for non-atherosclerosis cases, highlighting the need for individualized treatment strategies.
Impact:
- Surgical treatment for renovascular hypertension can be effective, with no operative mortality in this series.
- Prognosis is influenced by the underlying etiology, with atherosclerosis posing greater long-term risks.
- Angiotensin II analogue testing may aid in selecting appropriate surgical candidates.
Abstract:
Eleven cases of renovascular hypertension treated by the authors during the 10-year period from 1974 to 1984 are summarized in this paper, referring particularly to its etiology and prognosis. The causative diseases included 3 cases of atherosclerosis, 4 cases of fibromuscular dysplasia, 1 case of aortitis syndrome, 1 case of abdominal aneurysm, 1 case of renovascular thrombosis, and 1 case of unknown origin. Operations were given in 10 of the 11 cases i.e., 7 cases of nephrectomy and 3 cases of reconstructive surgery for renal blood-flow. The results of operations at discharge were 7 cases of blood pressure normalization, 2 cases of its improvement and 1 case of no change. There was no operative mortality. The outcome of long followup revealed that 2 of the 3 patients with atherosclerosis died in 9 months and 1 year and 10 months, respectively, due to cerebral hemorrhage and renal failure. However, the patients with other diseases maintained their health for 5 years and 5 months (mean observation period), with normal blood pressure or a mild hypertension. Sometimes, in patients with atherosclerosis in whom severe arteriosclerotic lesions already exist in the cardiovascular system, conservative therapy is better than surgical therapy. The indication for surgical therapy, should be made after considering the results of the angiotensin II analogue test.