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Surgical treatment of renovascular hypertension
Insights
Surgical intervention effectively treated hypertension in 56 patients with surgically correctable forms of high blood pressure. Postoperative results showed significant diastolic blood pressure reduction, improving outcomes for most patients.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- Hypertension is a significant health concern, particularly when diastolic blood pressure is inadequately controlled.
- Identifying surgically correctable causes of hypertension is crucial for effective management.
Purpose of the Study:
- To evaluate the efficacy of surgical treatment for patients with surgically correctable forms of hypertension.
- To assess the diagnostic methods used in identifying the causes of hypertension.
Main Methods:
- Utilized hypertensive intravenous pyelography and Hippuran renal scanning for detection.
- Employed aortography to confirm renal artery disease and renal vein renin assay to establish etiological significance.
- Performed renal artery reconstruction in 50 patients and nephrectomy in 6 patients.
Main Results:
- Surgical treatment was performed on 56 patients with surgically correctable hypertension.
- Mean diastolic blood pressure decreased from 118 mm Hg preoperatively to 86 mm Hg postoperatively.
- 85% of patients achieved a diastolic blood pressure of 90 mm Hg or less post-surgery.
Conclusions:
- Surgical intervention is a viable treatment option for specific forms of hypertension.
- Diagnostic imaging and biochemical assays are effective in identifying surgically correctable hypertension.
- The study demonstrates significant improvements in blood pressure control and patient outcomes following surgical correction.
Abstract:
The evaluation of patients with inadequate control of diastolic blood pressure for surgically correctable forms of hypertension led to the detection and surgical treatment of 56 patients. Detection was facilitated by the use of hypertensive intravenous pyelography and Hippuran renal Scanning. Aortography proved the presence of renal artery disease and renal vein renin assay established its significance in the etiology of the patients' hypertension. Renal artery reconstruction was performed in 50 patients, including 5 who also had reconstruction of major aortoiliac lesions. The extent of renal artery disease precluded arterial reconstruction in six patients, who required nephrectomy. Two postoperative deaths occurred, for a mortality rate of 3.6 per cent. Improvement in mean diastolic blood pressure for the total group of patients from 118 mm Hg preoperatively to 86 mm Hg postoperatively was achieved. Forty-six patients (85 per cent) have a diastolic blood pressure of 90 mm Hg or less; in 5 patients the diastolic blood pressure is 91 to 100 mm Hg but is at least 20 mm Hg lower than the preorative level.