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Renovascular Hypertension

Definition

Renovascular hypertension is high blood pressure in 1 or both of the renal arteries that supply blood to the kidneys.
The Kidney and its Main Blood Vessels
Renal Artery
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Causes

Renovascular hypertension is caused by renal artery stenosis, a narrowing of the artery in the kidney. This results in a decrease in blood flow to 1 or both kidneys.
Each kidney is capable of regulating the body’s blood pressure to assure that each organ has an adequate supply of oxygenated blood. Stenosis activates a cascade of hormones known as the renin-angiotensin system. This pattern increases blood pressure, which may result in renovascular hypertension. High blood pressure is a leading cause of stroke and heart attack.
The 2 most common causes of renovascular hypertension are:

Risk Factors

Factors that may increase your chance of renovascular hypertension include:

Symptoms

Problems with the renal arteries develop slowly and worsen over time. Most people do not experience symptoms of high blood pressure, so symptoms may go unnoticed.
In those that have symptoms, renovascular hypertension may cause:

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may take multiple blood pressure measurements over time and conduct blood tests to help diagnose your condition.
Kidney function can be evaluated with imaging tests. Tests may or may not use contrast material. Tests can include:

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Medications

Your doctor will first prescribe medication to help control your blood pressure. Because responses to medications vary, your doctor will monitor your blood pressure frequently and may adjust the type, combination, and/or dose of medication. Types of high blood pressure medications include the following:
  • Diuretics
  • Beta-blockers
  • Calcium channel blockers
  • Angiotensin-converting enzyme (ACE) inhibitors (except in those with both renal arteries blocked)
  • Angiotensin receptor blockers
  • Alpha-blockers
  • Vasodilators

Interventions to Correct Renovascular Hypertension

If you have severe, uncontrolled renovascular hypertension, your doctor may suggest interventions to restore blood flow to the kidneys. Types of interventions include:
  • Revascularization—A new path for blood flow to the kidneys is created by connecting a vein or tube above and below the blocked area.
  • Angioplasty—A catheter with a balloon at its tip is inserted into the blocked artery. The balloon is quickly inflated and deflated to stretch open the artery to allow blood flow. The doctor may insert a small metal mesh tube (stent) into the artery to help it stay open.
  • Endarterectomy—Surgery to remove the inner lining of the renal artery containing the plaque.

Prevention

To help reduce your chance of renovascular hypertension:

RESOURCES

Society for Vascular Surgery http://www.vascularweb.org

Urology Care Foundation http://www.urologyhealth.org

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca

Canadian Society for Vascular Surgery http://canadianvascular.ca

References

Fenves AZ, Ram CV. Renovascular hypertension: Clinical concepts. Minerva Med. 2006;97(4):313-324.

Renal artery stenosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 22, 2014. Accessed May 14, 2015.

Renovascular conditions. Society for Vascular Surgery website. Available at http://www.vascularweb.org/vascularhealth/Pages/renovascular-conditions.aspx. Updated November 11, 2009. Accessed May 14, 2015.

Renovascular disease. Patient UK website. Available at http://www.patient.co.uk/doctor/Renal-Vascular-Disease.htm. Updated July 19, 2012. Accessed May 14, 2015.

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