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[Clinical and angiographic characteristics of renovascular hypertension]
Insights
Renovascular hypertension in 95 patients revealed distinct angiographic patterns. Aortic arteritis often involved the aorta and both renal arteries, while fibromuscular dysplasia primarily affected one renal artery.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Radiology
Background:
- Renovascular hypertension (RVH) is a significant cause of secondary hypertension.
- Understanding the distinct clinical and angiographic features of different RVH etiologies is crucial for diagnosis and management.
Purpose of the Study:
- To characterize the clinical and angiographic differences among patients with renovascular hypertension due to aortic arteritis, fibromuscular dysplasia, and atherosclerosis.
Main Methods:
- Retrospective analysis of 95 patients diagnosed with renovascular hypertension.
- Classification into three groups: aortic arteritis (AA), fibromuscular dysplasia (FMD), and atherosclerosis (AS).
- Comparison of clinical data (age, hypertension history, abdominal bruit, serum potassium) and detailed angiographic findings.
Main Results:
- Atherosclerosis (AS) patients were older with longer hypertension history. Abdominal bruit was more frequent in aortic arteritis (AA).
- Aortic arteritis (AA) commonly affected the thoracic/abdominal aorta and bilateral renal arteries. Fibromuscular dysplasia (FMD) predominantly involved unilateral renal arteries, often with characteristic 'string of beads' appearance.
- Atherosclerosis (AS) showed ostial stenosis or obstruction in renal arteries, alongside aortic involvement.
Conclusions:
- Distinct clinical and angiographic profiles differentiate renovascular hypertension subtypes.
- Aortic arteritis, fibromuscular dysplasia, and atherosclerosis present unique patterns of vascular involvement, guiding diagnostic and therapeutic strategies.
Abstract:
Clinical and angiographic characteristics of renovascular hypertension were studied in 95 patients. The patients were divided into 3 groups: 55 cases with aortic arteritis (group AA), 27 with fibromuscular dysplasia (group FMD) and 9 with atherosclerosis (group AS). The patients in group AS were significantly older in age and had longer history of hypertension. Abdominal bruit was heard significantly more often in group AA and serum potassium was significantly lower in group FMD. Angiographic data showed that in group AA lesions in thoracic aorta and abdominal aorta was found in 81.4% and those involving both renal arteries in 52.5%. In group FMD, 82.5% of patients had lesion in renal artery on one side and none had lesion in thoracic and abdominal aorta. In group AS, lesions were found mainly in thoracic and abdominal aorta, accounting for 77.7% and lesions in renal arteries were mainly unilateral. In group AA, lesions were found in 90 renal arteries altogether. Among them, 58.9% was in the proximal part of the renal artery; the lesion was either localized stenosis (67.8%) or obstruction (17.7%). In group FMD, lesions were found in 33 renal arteries altogether. Among them, 48.5% was in the middle or distal part of the renal artery and 27.3% resembled string of beads. In group AS, a total of 10 renal arteries were involved with 4 (40%) of ostial stenosis and 4 (40%) total obstruction.