Could Renal Vascular Variations Be Associated with Resistant Hypertension? A Single-Center Study

Background: Anatomical variations in renal vessels are common in humans. However, the clinical significance of these congenital vascular abnormalities remains incompletely understood. This study aimed to assess the prevalence and characteristics of renal vascular variants in patients with arterial hypertension (HTN) and their association with the development of resistant HTN. Methods: We screened 3762 consecutive hypertensive patients hospitalized in our clinic and identified 128 (3.4%) with resistant HTN. These patients were matched with 128 hospitalized patients with controlled HTN. All participants underwent contrast-enhanced computed tomography imaging of the kidneys, including renovasography. Results: Anatomical renal vascular variations were identified in 64 (25%) of the 256 participants: 49 (38.3%) of the 128 patients with resistant HTN and 15 (11.7%) of the 128 patients with controlled HTN (p < 0.001). Among patients with renal vascular abnormalities, 76.6% had resistant HTN, while 23.4% had controlled HTN (p < 0.001). A regression analysis demonstrated a strong association between the presence of renal vascular variants and the development of resistant HTN, with an odds ratio of 4.67. Conclusions: Anatomical renal vascular variations were found to be common among hypertensive patients in this study and were strongly associated with the development of treatment-resistant HTN.