Reversible Renin-dependent Renovascular Hypertension Successfully Treated With Percutaneous Transluminal Renal Angioplasty and Stenting

Abstract

SUMMARYA 37-year old woman was suspected of having renovascular hypertension because of recent onset severe hypertension (blood pressure 220/135 mmHg; compared to 132/65 mmHg two years earlier) and an abdominal bruit. A captopril renal scan indicated the presence of right renal artery stenosis. Additionally, a captopril plasma renin activity (PRA) provocation test showed a positive result for renovascular hypertension (baseline PRA = 291 µU/mL; 1 hour post-captopril PRA = 1444 µU/mL). Selective renal angiography demonstrated a severe critical stenotic lesion at the distal portion of the right renal artery. Blood pressure (BP) decreased to 136/80 mmHg one day after successful percutaneous transluminal renal angioplasty and stenting. Repeat renal angiography six months after the procedure revealed no evidence of in-stent restenosis. Blood pressure (BP = 137/ 76 mmHg) and plasma renin profile (baseline PRA = 23.8 µU/mL; 1 hour post-captopril PRA=22.3 µu/mL) also were normal six months following initial revascularization. Moreover, blood pressure (137/84 mmHg) and renin profile remained normal 2.5 years after the procedure (baseline PRA = 24.3 µU/mL; 1 hour post-captopril = 25.6 µU/mL). The results of this study have thus demonstrated a case of renin-dependent renovascular hypertension in which both the blood pressure and plasma renin activity profile normalized following successful percutaneous transluminal angioplasty and stenting. (Int Heart J 2005; 46: 339-345)

Mild Renal Artery Stenosis Can Induce Renovascular Hypertension and is Associated with Elevated Renal Vein Renin Secretion

“…The elevated blood pressure response in renal artery stenosis (RAS) is predominantly attributed to the increased renin secretion from the diseased kidney . Renal vein renin sampling has been demonstrated in some studies as a clinical tool to assess the physiological significance of stenosis in the renal artery . Elevated renin mediates hypertension through activation of the renin aldosterone and the lipoxygenase pathway .…”

Plasma Renin Activity Predicts the Improvement in Resistant Hypertension after Percutaneous Transluminal Renal Artery Angioplasty

“…However, Fang et al reported a case of renovascular hypertension in which both the blood pressure and PRA were normalized using PTRA ( 22 ). In the present study, although antihypertensive agents used varied among individuals, no significant differences were noted in the specific medications used in the responder group versus the non-responder group.…”