Renovascular Hypertension

Renal hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys, is a form of what is called secondary hypertension, which is hypertension caused by another condition in the body.Renovascular disease is one of the most common causes of curable hypertension but accounts for < 2% of all cases of hypertension.

Its occurs more often in white men and blacks of both sexes. It occurs in approximately 10 out of 100,000 people. Age of onset depends upon the cause of damage to the kidney blood vessels. It often occurs in men over the age of 45 with atherosclerosis, and in women under the age of 45 with fibromuscular dysplasia. Around 10% of children with fibromuscular dysplasia also develop renovascular hypertension.

Renal  hypertension denotes the causal relationship between anatomically evident arterial occlusive disease and elevated blood pressure. When the arteries that carry blood to your kidneys become narrow because of atherosclerosis, which causes plaque deposits to collect in the renal artery, and fibromuscular dysplasia, in which cells from the artery wall overgrow and narrow the artery, less blood flows to the kidneys. The kidneys mistakenly respond as if your blood pressure is low and give off hormones that tell the body to hold on to more salt and water.

The response, the kidney produces a protein called renin. When renin is released into the bloodstream, it ends up being converted into an enzyme that makes the body retain sodium (salt) and constricts the arterioles, which causes the symptoms of renovascular hypertension. This causes your blood pressure to rise.

When renovascular hypertension is caused by a blood clot in a renal artery, the patient will usually have a sudden pain in the side and bloody urine.  Renovascular hypertension can lead to many serious complications, including hypertensive heart disease, stroke, blindness, myocardial infarction, congestive heart failure, blood vessel damage, kidney damage, and kidney failure. Techniques have been developed todiagnose renal hypertension using digital image processing of radiographs. Treatment may involve angioplasty and stenting of the renal arteries. The syndrome may be related to other diseases of the epithelium.

High blood pressure caused by narrowing of the arteries that lead to the kidneys (renovascular hypertension) is often difficult to control. There are a variety of high blood pressure medications available. Nitroprusside, labetalol, or calcium antagonists  are generally effective in lowering blood pressure acutely, although inhibitors of the RAA axis [e.g., ACE inhibitors, angiotensin II receptor blockers (ARBs)] are most effective long-term treatment, if disease is not bilateral.

Percutaneous transluminal angioplasty (PTA) is recommended for most patients, including younger patients with fibromuscular dysplasia of the renal artery. Cure rate is 90% in appropriately selected patients; surgical mortality rate is <  1%. Medical treatmentis always preferable to nephrectomy in young patients whose kidneys cannot be revascularized for technical reasons.

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Malignant Hypertension A hypertensive Emergency Condition

Malignant hypertension is usually defined as very high blood pressure with swelling of the optic nerve behind the eye, called papilledema (grade IV Keith-Wagner hypertensive retinopathy). This type of hypertension is more common in people with kidney problems such as narrowed kidney blood vessels.  The lower (diastolic) blood pressure reading, which is normally around 80 mmHg, is often above 130 mmHg.

Malignant hypertension is usually accompanied by other organ damage like heart failure, kidney failure, and hypertensive encephalopathy. The disorder affects about 1% of people with high blood pressure, including both children and adults. It is more common in younger adults, especially African American men. It also occurs in women with toxemia of pregnancytoxemia of pregnancy, and persons with kidney disorders or collagen vascular disordersvascular disorders. Like high blood pressure in general, the exact cause of malignant hypertension is not completely understood.

The kidneys are especially sensitive to increases in blood pressure and permanent kidney damage is a common complication of untreated malignant hypertension. You are at high risk for malignant hypertension if you have had kidney failure or renal hypertension caused by renal artery stenosis. Malignant hypertension is a medical emergency. Many body systems are in serious risk due to the extreme elevation of blood pressure.

Malignant Hypertension fact:

• Alternative Names: Accelerated hypertension; Arteriolar nephrosclerosis; Nephrosclerosis – arteriolar; Hypertension – malignant
• Younger patients are at higher risk than older patients, which is the opposite of the risk profile for essential hypertension
• Those of African heritage are at higher risk
• Anyone with a history of kidney failure or a disease called renal artery stenosis (narrowing of arteries in the kidney) has a greatly increased risk
• Pregnant women with gestational hypertension, or women experiencing certain pregnancy related complications (toxemia of pregnancy) appear to have an increased risk

Malignant Hypertension Symptoms Include:

• Blurry vision
• Chest pain
• Seizure
• Decreased urine output
• Weakness or strange tingling/numbness in the arms, legs, or face
• Headache
• Shortness of breath

Multiple organs of the body, including the brain, eyes, blood vessels, heart, and kidneys may sustain damage. The blood vessels of the kidney are highly susceptible to damage caused by pressure, and kidney failure may develop, which may be permanent. You willneed to stay in the hospital until the severe high blood pressure is under control. Medications will be given through a vein to reduce your blood pressure. Depending on how serious the problem is in a particular patient, admission to the Intensive Care Unit(ICU) may be required. If there is fluid in your lungs, you will be given medicines called diuretics, which help the body remove fluid. Your doctor will consider giving you medications to protect the heart if there is evidence of heart damage.?

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