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Yu MS, Xiang K, Haller ST, Cooper CJ. Renal Artery Interventions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Lestari S, Prasanto H, Kuswadi I. Renovascular Hypertension in Chronic Hemodialytic Patient. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Hypertension is a major contributor to the development of chronic kidney disease. Data in Indonesia, hypertension is still the most comorbid disease in CKD patients on dialysis (51%). Hypertension in CKD on dialysis patients is common and often uncontrolled. Renovascular hypertension is the most common cause of secondary hypertension. Diagnosis and treatment of RAS is very important, because it can accelerate the achievement of blood pressure targets, reduce the risk and complications due to hypertension.
Case Report: A 52-year-old woman with CKD has been undergoing hemodialysis for 2 years. Hypertension that was previously well controlled for 2 years required an increase in antihypertensive therapy from 2 to 4 drugs in recent months. On physical examination the blood pressure 180/90 mmHg, pulse 79 bpm, respiration 20/min, temperature 36.7oC. Conjunctiva looks anemic, cardiomegaly, lungs within normal limits, no ascites and edema in the extremities. On renal artery duplex ultrasound examination, right main renal artery acceleration time 147.65 ms, Peak Systolic Velocity (PSV) 31.9 cm/s. RI 0.69 and left main renal artery acceleration time 120.81 ms, PSV 16.9 cm/s, RI 0.61. There was 20-30% left renal artery stenosis, 80% right renal artery stenosis. A stent was placed on the right renal artery. The patient's condition after PTRA improved, but at the next follow-up, mean systole and diastole 170 mmHg and 80 mmHg, respectively. Patient received 4 antihypertensive therapy.
Conclusion: Renal artery stenosis is a disease that consists of a broad spectrum of different entities with different pathophysiologies that require varied approaches to diagnose and treat. Current diagnostic tools include MRA, CTA and renal artery duplex ultrasonography. Patients with renal parenchymal disease are poorer candidates for revascularization.
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Gates P. Arteriosclerosis with superimposed atherosclerosis is the cause not the consequence of essential hypertension. Med Hypotheses 2020; 144:110236. [PMID: 33254542 DOI: 10.1016/j.mehy.2020.110236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/22/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022]
Abstract
The arterial system is a closed loop and the pressure within this loop reflects cardiac output, resistance to outflow, volume of fluid within the circulation and stiffness of the arterial wall. Increased resistance to outflow or Bayliss's phenomena cannot be the cause of essential hypertension as it reverses with treatment of hypertension. There is no evidence for increased cardiac output in essential hypertension. Increased blood volume contributes to hypertension in obesity just as it does in hypertension secondary to renal failure. The principle cause of essential hypertension is increasing stiffness of the arterial wall. This is a consequence of arteriosclerosis that commences in utero and progressively increases in severity with increasing age. Arteriosclerotic arterial wall stiffening antedates the onset of essential hypertension by decades. It not only explains the increasing incidence of essential hypertension with increasing age, but it is the only thing that fulfils Koch's first postulate and that is it is present in 100% of individuals with essential hypertension.
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Affiliation(s)
- Peter Gates
- Deakin University, Waurn Ponds Vic 3220, Australia.
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Muzurović EM, Mikhailidis DP. Diabetes Mellitus and Noncardiac Atherosclerotic Vascular Disease-Pathogenesis and Pharmacological Treatment Options. J Cardiovasc Pharmacol Ther 2020; 26:25-39. [PMID: 32666812 DOI: 10.1177/1074248420941675] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Diabetes mellitus (DM) is also a cause of cardiovascular (CV) disease (CVD). Addressing the atherosclerotic CVD (ASCVD) burden in DM should reduce premature death and improve quality of life. Diabetes mellitus-associated ASCVD can lead to complications in all vascular beds (carotids as well as coronary, lower extremity, and renal arteries). This narrative review considers the diagnosis and pharmacological treatment of noncardiac atherosclerotic vascular disease (mainly in patients with DM). Based on current knowledge and the fact that modern DM treatment guidelines are based on CV outcome trials, it should be noted that patients with noncardiac CVD may not have the same benefits from certain drugs compared with patients who predominantly have cardiac complications. This leads to the conclusion that in the future, consideration should be given to conducting well-designed trials that will answer which pharmacological treatment modalities will be of greatest benefit to patients with noncardiac ASCVD.
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Affiliation(s)
- Emir M Muzurović
- Department of Internal Medicine, Endocrinology Section, 274294Clinical Centre of Montenegro, Ljubljanska bb, Podgorica, Montenegro.,Faculty of Medicine, University of Montenegro, Kruševac bb, Podgorica, Montenegro
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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Bhattad PB, Jain V. Renal Artery Stenosis As Etiology of Recurrent Flash Pulmonary Edema and Role of Imaging in Timely Diagnosis and Management. Cureus 2020; 12:e7609. [PMID: 32399343 PMCID: PMC7213650 DOI: 10.7759/cureus.7609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/09/2020] [Indexed: 12/24/2022] Open
Abstract
Renal hypoperfusion from renal artery stenosis (RAS) activates the renin-angiotensin system, which in turn causes volume overload and hypertension. Atherosclerosis and fibromuscular dysplasia are the most common causes of renal artery stenosis. Recurrent flash pulmonary edema, also known as Pickering syndrome, is commonly associated with bilateral renal artery stenosis. There should be a high index of clinical suspicion for renal artery stenosis in the setting of recurrent flash pulmonary edema and severe hypertension in patients with atherosclerotic disease. Duplex ultrasonography is commonly recommended as the best initial test for the detection of renal artery stenosis. Computed tomography (CT) angiography (CTA) or magnetic resonance (MR) angiography (MRA) are useful diagnostic imaging studies for the detection of renal artery stenosis in patients where duplex ultrasonography is difficult. If duplex ultrasound, CTA, and MRA are indeterminate or pose a risk of significant renal impairment, renal angiography is useful for a definitive diagnosis of RAS. The focus of medical management for RAS relies on controlling renovascular hypertension and aggressive lifestyle modification with control of atherosclerotic disease risk factors. The restoration of renal artery patency by revascularization in the setting of RAS due to atherosclerosis may help in the management of hypertension and minimize renal dysfunction.
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Affiliation(s)
| | - Vinay Jain
- Radiology, James H. Quillen Veterans Affairs Medical Center, Johnson City, USA
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Mamun F, Rahman MM, Zamila M, Subhan N, Hossain H, Raquibul Hasan S, Alam MA, Haque MA. Polyphenolic compounds of litchi leaf augment kidney and heart functions in 2K1C rats. J Funct Foods 2020. [DOI: 10.1016/j.jff.2019.103662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Dong H, Ou Y, Nie Z, Huang W, Liu Y, Zhou Y, Luo J, Li G. Association of renal artery stenosis with left ventricular remodeling in patients coexisting with renovascular and coronary artery disease. Vascular 2018; 27:190-198. [PMID: 30547720 DOI: 10.1177/1708538118819676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Data about renal artery stenosis association with left ventricular remodeling in patients coexisting with coronary artery disease are scanty. METHODS Patients with suspected both coronary artery disease and renal artery stenosis undergoing coronary and renal arteriography between October 2013 and December 2015 were prospectively enrolled. Left ventricular remodeling patterns were compared among different severity of renal artery stenosis group. Logistic regression was done to investigate the determinants of the left ventricular morphology. RESULTS The overall prevalence of left ventricular hypertrophy was 40.5%, the highest in bilateral renal artery stenosis group compared to unilateral or normal ones (65.4% versus 41.8% versus 34.8%, p = 0.012). Significantly lower estimated glomerular filtration rate and higher cystatin C level were found in bilateral renal artery stenosis group than that in other two groups. Multivariate regression analysis showed that bilateral renal artery stenosis was associated with increased left ventricular hypertrophy and concentric hypertrophy with statistical significance (adjusted odds ratio = 2.909 (95%CI: 1.063-7.961), and 3.021 (95%CI: 1.136-8.033)). In addition, estimated glomerular filtration rate level was also related to left ventricular hypertrophy, while there was no significant interaction between renal artery stenosis and coronary artery disease on left ventricular hypertrophy/concentric hypertrophy occurrence. CONCLUSIONS Bilateral renal artery stenosis is significantly associated with increased left ventricular hypertrophy/concentric hypertrophy in patients with suspected concomitant coronary and renal artery disease, while no synergic effect could be found in coronary artery disease.
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Affiliation(s)
- Haojian Dong
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Yanqiu Ou
- 2 Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Zhiqiang Nie
- 2 Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Wenhui Huang
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Yuan Liu
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Yingling Zhou
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Jianfang Luo
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Guang Li
- 1 Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
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Sakuma I, Saito J, Matsuzawa Y, Omura M, Matsui S, Nishikawa T. A Unique Case of Renovascular Hypertension due to Fibromuscular Dysplasia in an Extra-renal Artery. Intern Med 2018; 57:2689-2694. [PMID: 29709926 PMCID: PMC6191605 DOI: 10.2169/internalmedicine.0023-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 33-year-old man was admitted to our hospital to undergo an evaluation to determine the cause of secondary hypertension. Computerized tomography angiography (CTA) showed bilateral multiple renal arteries with significant stenosis of the right extra-renal artery due to fibromuscular dysplasia and segmental impairment of renal perfusion. Although the plasma aldosterone concentration and plasma renin activity were within the normal ranges, percutaneous balloon dilatation of the stenotic lesion resolved his hypertension, leading to a diagnosis of renovascular hypertension caused by segmental renal ischemia due to extra-renal artery stenosis. CTA should be considered during the examination of patients with early-age hypertension, even if the plasma renin activity is not sufficiently elevated.
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Affiliation(s)
- Ikki Sakuma
- Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Japan
- Department of Clinical Cell Biology & Medicine, Chiba University Graduate School of Medicine, Japan
| | - Jun Saito
- Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Yoko Matsuzawa
- Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Masao Omura
- Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Japan
| | - Seiji Matsui
- Department of Radiology, Yokohama Rosai Hospital, Japan
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Yu MS, Xiang K, Haller ST, Cooper CJ. Renal Artery Interventions. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Renal artery stenosis (RAS) is a frequently encountered problem in clinical practice. The disease encompasses a broad spectrum of pathophysiologies and is associated with three major clinical syndromes: ischemic nephropathy, hypertension, and destabilizing cardiac syndromes. The two most common etiologies are fibromuscular dysplasia and atherosclerotic renal artery disease with atherosclerotic disease accounting for the vast majority of cases. Atherosclerotic renovascular disease has considerable overlap with atherosclerotic disease elsewhere and is associated with a poor prognosis. A wide range of diagnostic modalities and treatment approaches for RAS are available to clinicians, and with the advent of endovascular interventions, selecting the best course for a given patient has only grown more challenging. Several clinical trials have demonstrated some benefit with revascularization but not to the extent that many had hoped for or expected. Furthermore, much of the existing data is only marginally useful given significant flaws in study design and inherent bias. There remains a need for further identification of subgroups and appropriate indications in hopes of maximizing outcomes and avoiding unnecessary procedures in patients who would not benefit from treatment. In recent decades, the study of RAS has expanded and evolved rapidly. In this review, we will attempt to summarize the amassed body of literature with a focus on the epidemiology of RAS including prevalence, overlap with other atherosclerotic disease, and prognosis. We will also outline existing diagnostic and treatment approaches available to clinicians as well as summarize the findings of several major clinical trials. Finally, we will offer our perspective on future directions in the field.
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Acelajado MC. Optimal management of hypertension in elderly patients. Integr Blood Press Control 2010; 3:145-53. [PMID: 21949630 PMCID: PMC3172073 DOI: 10.2147/ibpc.s6778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Indexed: 12/27/2022] Open
Abstract
Hypertension is a common and important modifiable risk factor for cardiovascular and kidney diseases. The prevalence of hypertension, particularly isolated systolic hypertension, increases with advancing age, and this is partly due to the age-related changes in the arterial tree, leading to an increase in arterial stiffness. Therapeutic lifestyle changes, such as reduced dietary sodium intake, weight loss, regular aerobic activity, and moderation of alcohol consumption, have been shown to benefit elderly patients with hypertension. Lowering blood pressure (BP) using pharmacological agents reduces the risk for cardiovascular morbidity and mortality, with no difference in risk reduction in elderly patients compared to younger hypertensives. Guidelines recommend a BP goal of <140/90 in hypertensive patients regardless of age and <130/80 in patients with concomitant diabetes or kidney disease, and lowering the BP further has not been shown to confer any additional benefit. Moreover, the choice of antihypertensive does not seem to be as important as the degree of BP lowering. Special considerations in the treatment of elderly hypertensive patients include cognitive impairment, dementia, orthostatic hypotension, and polypharmacy.
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Affiliation(s)
- Maria Czarina Acelajado
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
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