Effect Of Congenital Renal Artery Variations On Blood Pressure

Background:Renal hypertension is the most common secondary hypertension.Some people have congenital variations in the renal arteries,including the accessory renal arteries and early branches of the renal artery.Some scholars have suggested that congenital variations in the renal arteries can cause blood pressure to rise.However,some other scholars believe that the congenital variations of the renal artery are only anatomical variations and will not affect blood pressure.Whether the congenital variations of the renal artery will affect blood pressure has been debated for nearly 70 years,and it is still unclear.In addition,radiofrequency renal denervation is an emerging technology for the treatment of resistant hypertension,but the effectiveness of this surgery is not satisfactory.Some scholars have suggested that the accessory renal arteries affect the efficacy of radiofrequency renal denervation.The rapid development of imaging technology in the past 20 years,especially the emergence of multi-slice spiral computed tomography angiography(MSCTA),has made it no longer difficult to screen the accessory renal arteries and early branches of the renal artery.However,there are still few studies on the correlation between the renal artery variations and hypertension.More importantly,the results of these studies are very different,and even the conclusions of some studies are opposite.Generally speaking,whether the congenital variations of renal artery will lead to the rise of blood pressure and the mechanism of its effect on blood pressure are still unclear.Objective:The purpose of this study was to investigate the effects of accessory renal arteries and early branches of the renal artery on blood pressure,and the mechanisms that influence blood pressure.Methods:This study reviewed all subjects in a cohort of vascular health in XX communities.Subjects with secondary hypertension,subjects with unclear abdominal CTA images,and incomplete baseline data were excluded.All subjects with congenital renal artery variation were identified by abdominal CTA images,and all subjects were divided into the accessory renal artery group,early branches group and non-variation group according to the type of renal artery variation.Baseline data,blood pressure values,Hypertension prevalence and renin levels were compared.Results:A total of 2568 subjects were enrolled in this study,including 339 in the early branchings group,280 in the accessory renal arteries group,and 1949 in the normal group.The prevalence of hypertension in the accessory renal artery group was higher than that in normal group(57.50% vs.46.49% P < 0.01),and there was no significant difference between the early branch group and the normal group(49.56% vs.46.49% P = 0.30).The presence of accessory renal artery(OR = 2.07,95% CI 1.51-2.63,P < 0.01)is a risk factor for hypertension.The average renin activity level of the accessory renal artery group was higher than that of the normal group(1.84 ± 0.71ng/ml/h vs.1.32 ± 0.87ng/ml/h,P < 0.01).There was no significant difference between the early branch group and the normal group(1.39 ± 0.80ng/ml/h vs.1.32 ± 0.87ng/ml/h,P = 0.73).Conclusion:The overall incidence of renal artery variation was about 24%.The presence of the accessory renal artery is a risk factor for hypertension.The mechanism of the increase of blood pressure caused by the accessory renal artery may be related to the activation of the renin-angiotensin-aldosterone system.