[Arterial hypertension in periarteritis nodosa. 37 case reports]

Hypertension in periarteritis nodosa poses the problem of aetiology, prognostic significance and treatment. Thirty seven cases of periarteritis noda with hypertension were analysed with à follow-up of over 10 years. These cases were taken from a series of 91 patients with polyarteritis nodosa admitted to the Department of Internal Medecine at the Pitié Hospital, between 1960 and 1980. Hypertension was observed on admission in 40% of the patients and developed during the first year of the disease in another 40%. The prognosis of patients with polyarteritis nodosa and hypertension is not significantly different from those without hypertension during the first six years. The overall prognosis depends mainly on the degree of renal involvement. The hypertension is renovascular in a number of cases due to ischaemia of the renal cortex. This was demonstrated by renal arteriography or by evaluating plasma renin activity in the renal veins. In some cases, especially those in which the hypertension preceded the periarteritis nodosa, the hypertension seemed to progress independently. In some cases, however, it was not possible to determine the relationship between the periarteritis nodosa and the hypertension or confirm that this association was coincidental. The use of angiotensin I converting enzyme inhibitors is an important advance in the treatment of the hypertension of periarteritis nodosa with high plasma renin activity as it counteracts the exact mechanism of the hypertension. Their use is justified in high plasma renin activity hypertension of periarteritis nodosa; patients who fail to respond may be treated with betablockers or other antihypertensive drugs.