Renovascular Hypertension:4Cases Report

Objective Clinical data were retrospectively analyzed in4cases to discuss how the diagnose and management of patients with renovascular hypertension （RVH）effect their blood pressure (BP) control and complications.Results Case1was a74-year-old woman who had had uncontrolled hypertension while taking four kinds of antihypertensive drugs and increased serum creatinine concentration for3months. The patient had a past medical history of hypertension for30years and diabetes mellitus for8years. Examination showed multiple atherosclerosis and increased peripheral plasma renin-angiotensin-aldosterone system (RAAS) activity increased. Then the patient was undergone percutaneous renal artery angioplasty and stenting (PRAS). During1-year-follow-up, the patient’s BP could be controlled by sustained release nifedipine30mg/d and her serum creatinine concentration had returned to normal. Conclusion: Proper revascularization may result in better blood pressure control and renal function. Case2was a72-year-old male whose chief complaints were dizziness and extremely high BP for a month. He had a medical history of hypertension for10years. His head Computed Tomography (CT) showed ischemic infarction in right occipital lobe with malacia. After examination, he was diagnosed as multiple atherosclerosis with normal peripheral plasma RAAS activity. His BP was unstable after using four kinds of antihypertensive drugs. After PRAS, his BP was significantly decreased but then he had a recurrent cerebral infarction. Conclusion: It is critical to determine the timing of revascularization, especially patients with unstable clinical condition. Case3was a32-year-old female with hypertension and had an increased peripheral plasma RAAS activity. Computed Tomography Angiography (CTA) showed the "string-of-beads" stenosis of right renal artery. After PRAS, her BP returned normal during2-year-follow-up. Conclusion: Early diagnose and treatment of RVH caused by fibromuscular dysplasia (FMD) may cure patient’s hypertension. Case4was a44-year-old male with recurrent episodes of acute heart failure and refractory hypertension. On examination, his upper-limb BP was much higher than lower-limb BP. His peripheral plasma RAAS activity was normal and CTA showed abdominal aorta from infrarenal aorta to bilateral iliac arteries including bilateral renal arteries were almost occluded. The patient’s general condition improved and was discharged after the subclavian artery to femoral artery artificial vascular bypass sugery.Conclution It is important to pay close attention to the diagnosis and treatment of RVH for controlling blood pressure and its related complications in hypertensive patients. Increased peripheral plasma RAAS activity may predict functional recovery of the kidney.