Effect Of Accessory Renal Artery On Clinical Features Of Patients With Primary Hypertension

Background: Hypertension is one of the risk factors for serious cardiovascular and cerebrovascular diseases.Long-term uncontrolled hypertension can cause a variety of cardiovascular and cerebrovascular complications.It is one of the common chronic non-communicable diseases with high disability and mortality,which seriously consumes medical and social resources.According to the 2017 China heart congress survey of Chinese residents,the prevalence of hypertension among Chinese adults is about 23.0%,with a total of 243.5 million people,and the prevalence of hypertension among adults is increasing day by day.Recent studies have found that 22-28.2% of patients with hypertension have unilateral or bilateral accessory renal arteries.The secondary renal artery is the most common and important renal artery variation,which does not enter the kidney through the renal hilum.The accessory renal artery is longer and thinner than the main renal artery,which damages the perfusion of the corresponding blood supply area.Secondly,the accessory renal artery can disturbe the human kidney microcirculation,resulting in increased renin secretion.However,it is still unclear that whether the accessory renal artery affects blood pressure level in patients with essential hypertension.Objective: To observe and compare the relevant clinical indicators of primary hypertensive patients with and without accessory renal artery,and to explore and analyze whether accessory renal artery can affect the blood pressure level of patients with primary hypertension through sympathetic excitation,as well as other clinical characteristics.The results of this study will provide a certain theoretical basis for whether the accessory renal arteries should be ablated during the operation of renal denervation.Methods: From June 2017 to January 2019,162 patients with primary hypertension were selected and diagnosed in the hypertension ward of the First Affiliated Hospital of Dalian Medical Universuty.According to the results of renal artery computed tomograph(CT),there were 54 patients with accessory renal artery and 108 patients without accessory renal artery.The background and clinical data of these patients were collected.IBM SPSS 23.0 software was used for statistical analysis,and the difference was statistically significant when P < 0.05.Results: The incidence of accessory renal arteries in patients with primary hypertension was about 33.33%,and it was more common in males,with a ratio of 1.7:1.In the general data,there were no statistical differences in gender,age,duration of hypertension,body mass index(BMI),smoking history,drinking history,total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homocysteine,and glycosylated hemoglobin.The patients in the accessory renal artery group had higher renin concentration in horizontal position and vertical position than those in the non-accessory renal artery group,and their mean systolic and diastolic blood pressure during the day,mean systolic and diastolic blood pressure at night,and mean systolic and diastolic blood pressure throughout the day were all higher than those in the non-accessory renal artery group,which had statistical significance.Compared with the group without accessory renal arteries,patients in the accessory renal arteries group had more serious heart damage and a slight increase in serum creatinine.Recumbent renin was positively correlated with accessory renal artery,recumbent aldosterone,urinary microalbumin/creatinine,and heart rate,while negatively correlated with age,serum sodium,and serum potassium.Mean all-day systolic and diastolic blood pressure were positively correlated with accessory renal artery,age,creatinine,uric acid,recumbent renin,and BMI,while mean all-day systolic and diastolic blood pressure were negatively correlated with HDL cholesterol.The accessory renal artery may affect the mean systolic blood pressure and the level of recumbent renin throughout the day.Conclusion: In patients with primary hypertension accompanied by accessory renal arteries,hyperexcitability of sympathetic nerves may lead to higher blood pressure and severer damage to target organs.Therefore,stricter blood pressure control should be achieved in these patients.In renal denervation,ablation of the major renal arteries and the accessory renal arteries may provide better control of blood pressure in hypertensive patietns.