Current Approaches to Renovascular Hypertension

Textor, Stephen C.

doi:10.1016/j.mcna.2009.02.012

Cited by 53 publications

(33 citation statements)

References 43 publications

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“…Si hay una EAR significativa la hipoperfusión producida activa el sistema renina-angiotensina-aldosterona, provocando retención hidrosalina 5 . Normalmente, el riñón contralateral sano puede contrarrestar la retención hidrosalina realizando una natriuresis por presión 7,8 , restaurando de esta manera el volumen intravascular 5,7 . En pacientes con estenosis crí-tica bilateral o unilateral en riñón único este mecanismo se pierde y la hipervolemia favorece los episodios de edema pulmonar 7,9 , especialmente durante la noche debido al patrón dipping de la PA, que compromete aún más la perfusión renal 2-4 .…”

Section: Discussionunclassified

“…De hecho, el síndrome de Pickering merece considerarse una verdadera emergencia hipertensiva 4 . Para objetivar la estenosis, la arteriografía renal es el gold-standard 7,[9][10][11] , aunque en nuestro país la angio-RM, que no utiliza contraste nefrotóxico, se utiliza como prueba diagnóstica inicial.…”

Section: Discussionunclassified

“…Aunque hay dudas sobre la utilidad del tratamiento intervencionista en la patología vasculorrenal en general 7,9-12 , los pacientes con síndrome de Pickering se benefician más de este enfoque terapéutico que los pacientes con estenosis ateromatosa unilateral y riñón contralateral funcionante [4][5][6][7][8][9][10][11][12][13] . La ATP con colocación de un stent endovascular permite el buen control tensional, la mejoría de la función renal y la desaparición de los episodios de EAP 6,9,[11][12][13] .…”

Section: Discussionunclassified

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Síndrome de Pickering – estenosis de arteria renal y flash edema pulmonar. Nueva denominación de un concepto antiguo

Faur

Torguet

Martin

et al. 2011

Hipertensión y Riesgo Vascular

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Section: Discussionunclassified

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Síndrome de Pickering – estenosis de arteria renal y flash edema pulmonar. Nueva denominación de un concepto antiguo

Faur

Torguet

Martin

et al. 2011

Hipertensión y Riesgo Vascular

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“…Renal artery stenosis caused by fibro-muscular dysplasia (in young adults, especially women) or atherosclerotic renal artery stenosis (in elderly) will lead to activation of RAASand sodium retention,and then, at least in initial stage [15], result in Reno-vascular hypertension. The presence of an abdominal bruit should lead to a workup for Reno-vascular hypertension.…”

Section: ) Reno-vascular Hypertensionmentioning

confidence: 99%

Progression in Diagnosis and Treatment of Resistant Hypertension

He¹,

Mu²,

Liu³

et al. 2014

J Cardiovasc Med Cardiol

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Introduction: Resistant Hypertension (RH) is a major risk factor of numerous diseases. RH is a challenging clinical problem,many factors affect blood pressure (BP) control. Correct diagnosis and appropriate drug therapy are pretty important to get BP controlled. We aim to attract physicians' attention to adopt correct measures to diagnose and treat RH.Method: Articlesare obtained from the Internet, www.pubmed.com, Medline and several authors via e-mail.Result and Conclusion: 1.Using a systematic approach to find out the causes of RH and the distinctions between pseudo-resistance and true resistance areof importance for treatment. 2. Following the current treatment guidelines and using the standardized way to establish a flowchart to manage the patientsare the correct methods for BP control. 3. In the absence of novel antihypertensive drugs targeting new pathways, device-based therapies including RDN, carotid baroreflex activation and continuous positive airway pressure (CPAP) have shown encouraging results. 4. Further efforts on the pathophysiology of RH will help to establish better drug combinations or new ways on BP control. and treatment of RH to attract physicians' attention to adopt correct measures to diagnose and treat RH. Discussion PrevalenceStrictly speaking, RH is not a definition of disease, but of management. So it is difficult to get its correct prevalence. Because of this, its prevalence is still unclear. Some large-scale clinical trials intended to figure out the prevalence of RH in overall population and hypertensive populationare shown below.According to the latest data from ESH/ESC [1], the prevalence of RH is around 5%-30% of the overall hypertensive populationwithfigures less than 10% probably representing the true prevalence. Arepresentative survey carried out by American National Health and Nutrition Examination [2] including > 15 000 non-pregnant adults between 2003 and 2008 found that resistant hypertension criteria were met in 8.9% of all individuals with hypertension, and in 12.8% of the hypertensive drugs treated population. A complete database for 7.9 years from Olivetti Heart Study (OHS) in southern Italy [3] showed that the prevalence of RH was 4.8% in the whole study population, and 10.1% in hypertensive participants. It seems that the prevalence ofRHis around 10% in hypertensive population, butsituations including treatment adherence, white coat hypertension and secondary hypertension were not reported. Another more detailed research by Stacie et al [4] demonstrated thatafter the exclusion of those who lost baseline data or failed to adhere to the research, the inadequate number of antihypertensive drugs, and poor medication adherence,the prevalence of true RH was only 1.9%among 205750 patients. It is, Abbreviations

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“…Antihypertensive drug therapy with angiotensin-converting-enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARBs) is extensively used for controlling blood pressure, and at times for salvaging the function of the ischemic kidney [3]. This approach is supported by several studies that suggested considerable survival advantages for patients treated with these drugs [4,5].…”

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confidence: 99%