Renovascular Hypertension

Overview:

Renovascular hypertension is a condition where there are higher blood pressure levels, and the kidneys contribute to this increased level. It happens due to the narrowing of the arteries carrying the blood to the kidneys. The other name for renovascular hypertension is renal artery stenosis. There are various causes and risk factors associated with renovascular hypertension. There are several treatment options. Surgical methods are known to be highly beneficial. The patient should be educated about their condition so that they can take care of their health in a better manner.

What Is the Epidemiology of Renovascular Hypertension?

Renovascular hypertension is known to be the second most common condition occurring in the United States of America. Older people are most commonly affected than younger people. In some patients, renovascular hypertension can occur at the age of 30, while in others, it can affect patients who are more than 50 years of age.

What Are the Causes of Renovascular Hypertension?

The main cause of renovascular hypertension is higher levels of cholesterol. The risk is increased when a fatty substance is known to thicken the inner lining of the arteries. This fatty substance is known as plaque, and this condition is referred to as atherosclerosis. The narrowing of the arteries results in reduced blood flow than normal. In response to this, the kidneys release hormones that lead to increased salt and water retention. As a result, blood pressure increases. A few conditions are known to cause renovascular hypertension. They are:

• Acute arterial thrombosis or embolism.

• Cholesterol embolic disease.

• Renal arterial trauma.

• Aortic dissection.

• Arterial aneurysm.

• Polyarteritis nodosa.

• Arteriovenous malformation of the renal artery.

Does Renovascular Hypertension Affect Children?

In children, renovascular hypertension can occur both in congenital and acquired forms. The acquired type of renovascular hypertension is known to be more common than the congenital type. The occurrence of this health condition might vary in different geographical regions. The acquired type of renovascular hypertension can show the following conditions. They are:

• Moyamoya disease.

• Subisthmic coarctation.

• Kawasaki disease.

• Takayasu arteritis.

• Vasculitis.

• Renal artery thrombosis.

• Vascular trauma.

• Anastomotic stenosis.

• Midaortic syndrome.

• Tumors.

What Are the Signs and Symptoms of Renovascular Hypertension?

The condition of renovascular hypertension will show the following signs:

• Rapid buildup of fluid in the lungs will result in pulmonary edema.

• There will be narrowing of the arteries in the legs, eyes, and brain.

• Improper functioning of the kidneys.

• Increased blood pressure in younger patients.

• Uncontrolled levels of blood pressure even after the intake of medications.

What Are the Complications of Renovascular Hypertension?

The complication associated with renovascular hypertension are:

• Chronic kidney disease.

• Headache.

• Poor blood supply to the legs.

• Aortic aneurysm.

• Heart failure.

• Confusion.

• Blurred vision.

• Bleeding of the nose.

• Nausea and vomiting.

• Heart attack.

• Stroke.

What Are the Risk Factors of Renovascular Hypertension?

The risk factors associated with renovascular hypertension are:

• Smoking.

• High blood pressure.

• Increase in age.

• Higher levels of cholesterol.

• Diabetes.

• Cocaine abuse.

• Consumption of heavy alcohol.

What Are the Diagnostic Procedures for Renovascular Hypertension?

In the initial stages, diagnosis is made using ultrasonography and magnetic resonance angiography. In some patients, procedures like radionuclide imaging are used. Confirmatory diagnosis is achieved by renal angiography. This procedure can also be used for therapeutic procedures. Renal angiography is a highly beneficial test. It would require a few other tests like radionuclide imaging, magnetic resonance angiography, and ultrasonography to identify whether the patient is eligible for the renal angiography test.

Duplex doppler ultrasonography is also a useful diagnostic test that can identify the blood flow to the kidneys. It is a non-invasive procedure, and it is usually reliable. Stenosis in the renal arteries can be identified with this method. It is a technique sensitive procedure and would require qualified technicians to perform the test.

Radionuclide imaging is a diagnostic procedure that is done before and after the administration of drugs like Captopril. It is an angiotensin-converting enzyme inhibitor (ACE inhibitor). It will help in treating the narrow affected artery.

Digital subtraction angiography is a diagnostic procedure in which the renal arteries are given a selective injection to make a confirmatory diagnosis.

What Are the Treatment Options for Renovascular Hypertension?

The treatment requires certain lifestyle modifications and medications. The patient should be aware of the cholesterol levels as it can increase the risk of other conditions.

• Lifestyle Changes: A healthy heart is a way to get cured of renovascular hypertension. A balanced and fat-free diet will be required for faster recovery. It is essential to exercise for a minimum of 30 minutes per day. If you are a smoker, then you should quit the habit of smoking. Alcohol must be completely avoided. It is necessary to reduce the sodium intake in your diet. The ideal level of sodium should be maintained at less than 1500 mg per day. It is necessary for you to check with your doctor regarding the potassium levels. Stress is an important contributor to weight gain. The levels of stress can be reduced by practicing yoga and meditation techniques.

• Medical Treatment: The doctor will record a thorough history of the patient. After considering all the past medical history and other associated diseases, the patient will be prescribed medications to treat atherosclerosis, hypertension, and renal disorders. The treatment is always aimed at improving the condition of the kidney. If the kidney cannot be vascularized again, then the patient is recommended for a nephrectomy.

• Surgery: Angioplasty is done for patients who are having fibromuscular dysplasia. It is a procedure with low risk, and so it can improve the control over blood pressure. Balloon angioplasty is the treatment that is suggested for obstructions in the renal artery. This is done with or without the placement of the stent. A stent placement will reduce the risk of reoccurrence of stenosis. In some patients, bypass surgery would be required. Saphenous vein bypass graphene is a procedure that is recommended for diseases in the renal artery.

What Are the Precautionary Measures?

• If you have increased blood sugar levels or positive signs for diabetes, you should try to cure it first.

• Try to keep a check on your cholesterol levels on a regular basis.

• Quit smoking, alcohol, and drug usage.

How Is the Prognosis?

If the blood pressure is relatively higher, then the prognosis is very poor. Proper control of hypertension will help the patient to escape from complications and retain a long life.