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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renovascular hypertension alters endothelial-dependent mechanisms to affect the response of small arterioles in skeletal muscle to sepsis. Small arteriole responses to sepsis differ between skeletal muscle and small intestine in normotensives. Our study now shows that renovascular (1K1C) hypertension alters small arteriole responses in the small intestine to Escherichia coli sepsis. Large arterioles (A1, A2) constricted by 10-20% in the small intestine of both normotensive and hypertensive rats during both high and low cardiac output sepsis. Small arterioles (premucosal A3 and preserosal A4) constricted during high cardiac output sepsis in normotensive but not hypertensive rats. Small A3 and A4 arterioles dilated (20-40%) during low cardiac output sepsis in hypertensives; but only A3 and not A4 arterioles dilated in normotensives during low cardiac output sepsis. Acetylcholine, which releases endothelial-derived relaxing factor in skeletal muscle, dilated both premucosal A3 and preserosal A4 in both normotensive and hypertensive rats. Thus, hypertension alters small arteriole responses to sepsis in both skeletal muscle and small intestine, but apparently by different mechanisms.
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PMID:Altered microvascular responses of the small intestine to sepsis during renovascular hypertension. 774 28

Renovascular hypertension is one of the more common causes of secondary hypertension. The true prevalence of this condition is not known, because only a selected few with hypertension are considered for thorough diagnostic work-up. The higher incidence figures come from centers with a special interest in this disease. The ability of a clinician to detect renovascular hypertension has improved substantially, thanks to the advances in radiology. The predominant mechanism of blood pressure elevation from renal ischemia is activation of the renin-angiotensin system. Clinically, the pathological lesions that cause renal artery stenosis are atherosclerosis and fibromuscular dysplasia; the former is typically seen in older men, and the latter is typically found in young women. Suspicion of the presence of renovascular disease should prompt the physician to obtain appropriate screening and confirmatory tests. Once diagnosed, the management of patients with renovascular hypertension requires a carefully planned multidisciplinary approach to offer the patient a best possible therapeutic option, with surgical revascularization or balloon angioplasty, or chronic medical therapy. However, these options are not mutually exclusive. The best long-term results are obtained with surgical therapy. Although balloon angioplasty is being increasingly used perhaps as the preferred initial therapeutic procedure for many patients with renal artery stenosis, long-term results comparable with surgery are not yet available. The ideal rational therapy for patients with renal artery stenosis is reperfusion of the ischemic kidney either by surgical correction or by balloon dilation. The aim is not only to improve the blood pressure control, but also to prevent and at times to reverse renal failure. Although effective antihypertensive drugs have become available, the role of medical management of renovascular hypertension is shrinking and should be limited to patients who have contraindications to or unwilling to undergo corrective procedures to relieve renal ischemia.
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PMID:Renovascular hypertension. 777 25

A case of multivessel fibromuscular dysplasia involving the cervico-cephalic arteries, the right renal artery and the iliac arteries is reported. It was associated with reversible bilateral internal carotid arteries and vertebral arteries dissection, left thalamic infarct, right hemorrhagic cerebellar infarct, renovascular hypertension and intermittent claudication of the right lower limb. This report indicates that fibromuscular dysplasia is a systemic angiopathy. Renovascular hypertension may foster the appearance of complication such as dissection of the arteries affected by fibromuscular dysplasia. In the case investigated the dissection of cervico-cephalic arteries was followed by spontaneous healing and a favourable neurological outcome whereas at the iliac arteries a rapid deterioration was observed.
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PMID:Fibromuscular dysplasia. A case report with multivessel vascular involvement. 779 Jul 59

Moyamoya disease is a rare disorder characterized by progressive occlusive cerebral arteriopathy associated with an extensive network of collateral vessels. Renovascular hypertension has rarely been associated with this disease. We report on a girl with renovascular hypertension and 2 renal artery aneurysms who was found to have moyamoya disease. Successful surgical treatment was achieved with extracorporeal arterial repair and renal autotransplantation. The relationship between moyamoya disease and renovascular hypertension is reviewed.
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PMID:Surgical treatment of renovascular hypertension in moyamoya disease: case report and review of the literature. 781 17

We report a 2-year-old boy with renovascular hypertension caused by stenosis of the left renal artery that was successfully treated by percutaneous transluminal angioplasty (PTA). He initially presented with severe hyponatremia, hypokalemia, polyuria, transient proteinuria and weight loss. This phenomenon is known to occur in patients with renovascular and malignant hypertension, called hyponatremia hypertensive syndrome, but was thought to be rare in children. Renovascular hypertension should be considered as a cause of hyponatremia in children. In addition, PTA is an appropriate treatment even in very young children with renovascular hypertension.
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PMID:Severe hyponatremia in a patient with renovascular hypertension: case report. 783 Aug 65

Renovascular hypertension is one of the most common causes of secondary hypertension. Its early diagnosis is particularly important, firstly because it is one of the few potentially reversible causes of chronic renal failure. In many centers, including our own, renal angioplasty (PTA) or surgery is the treatment of choice for patients with renovascular hypertension. The aim of the study was the evaluation of the early and late results of PTA versus renovascular surgery. The diagnostic procedures and clinical course of renovascular hypertension were also analyzed. Among patients with renovascular hypertension treated in our Department during the 1981-1993 years, 89 patients (46 men, 43 women) were diagnosed and having renovascular hypertension (3% of all hypertensive patients). The average duration of hypertension in this group was 5 years. High incidence of accelerated hypertension (18%) and cardiovascular complications were observed: myocardial infarction in 20.2% of cases and stroke in 4.5%. The presence of renal failure was found in 22.5% of cases, hypokalemia in 11.2%, 38.3% of patients had changes in other arteries. Renal angioscintigraphy and captopril renal scintigraphy were performed in accordance with renal arteriography in 80% of patients. Arteriography showed unilateral renal artery stenosis in 78.7% of patients and bilateral - in 21.3%. The most common cause of renovascular hypertension in our material was atherosclerosis (65.2%). Fibromuscular dysplasia and Takayasu arteritis were diagnosed less frequently (25.8% and 9.0% respectively). Forty four patients were treated with PTA, 15 underwent surgical revascularization and 11 - unilateral nephrectomy. Early beneficial therapeutic effect (normalization or improvement of blood pressure control) was observed in 88.6% for PTA and 66.7% for surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Renovascular hypertension--clinical observations and long-term follow-up]. 787 Dec

Percutaneous transluminal renal artery angioplasty (PTRA) is an alternative to treatment with drugs and surgery for renovascular hypertension and uremia. The procedure is technically successful in more than 90% of the patients. Renovascular hypertension is cured or improved in nearly 2/3 of the patients. Uremia is cured in 50%, and in another third the kidney function is stabilized. The frequency of restenosis is high, especially for ostial lesions. Therefore, clinical and angiographic follow-up is recommended, so as to redilate when restenosis is present. Introduction of stents probably reduces the frequency of restenosis in the ostial lesions.
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PMID:[Catheter treatment of renal artery stenoses]. 799 16

Vasodilation of small arterioles in skeletal muscle during sepsis is an endothelium-dependent response. Renovascular hypertension significantly attenuates this response. Complement activation by zymosan infusion causes small arteriole dilation in skeletal muscle similar to that seen during sepsis. This study was conducted to show whether renovascular hypertension alters the skeletal muscle microcirculatory responses in normotensive rats to systemic activation of the alternative complement system. We found that hypertension abolished the constriction of large A1 arterioles (+3 +/- 2% change at 45 min) and dilation of small A4 arterioles (-2 +/- 2% change at 45 min) in skeletal muscle. Hypertension attenuated but did not abolish (A4: +70 +/- 13% change in hypertensive vs +111 +/- 18% in normotensive rats) the ability of small arterioles to dilate to nitroprusside, an endothelium-independent vasodilator. This suggest that hypertension modifies some type of receptor-level mechanism to reduce small arteriolar dilation during complement activation. We next used hydroquinone to topically block endothelium-derived relaxing factor (EDRF) in hypertensive animals whose complement systems were activated. Hydroquinone did not change the response of large A1 arterioles (+5 +/- 4% hydroquinone change vs +3 +/- 2% non-hydroquinone at 45 min) to complement activation. However, hydroquinone allowed construction of small A4 arterioles (-12 +/- 5% hydroquinone change vs -2 +/- 2%, non-hydroquinone at 45 min) during complement activation in hypertensive rats. We conclude that during hypertension the release of EDRF in small arterioles after complement activation is counterbalanced by a constrictor-producing mechanism.
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PMID:Microcirculatory responses to complement activation are blunted by hypertension. 804 81

We report a case of hyponatremia, polyuria-polydipsia, hypokalemia, nephrotic syndrome, and hypertension caused by unilateral renal ischemia, and the resolution after nephrectomy of the ischemic kidney. The renin-angiotensin-aldosterone axis seems to play an essential role in the pathogenesis of these features. Mechanisms by which angiotensin II, hypokalemia, and proteinuria can affect salt and water balances, and the role of angiotensin II as a cause of heavy proteinuria are discussed. Renovascular hypertension should be considered in the differential diagnosis of hyponatremia, hypokalemia, and polyuria-polydipsia.
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PMID:Multiple manifestations of renovascular hypertension. 820 70

Sensitivity and specificity of captopril renoscintigraphy (CRS) with Tc-99m DTPA has been analyzed in 41 cases, 16 with renovascular hypertension (RVH) and 25 with non-RVH. The sensitivity and specificity of the baseline study were 63% (10/16) and 63% (12/19), respectively, based on the split renal function study in which the lower limit of normal was assumed to be 42% of the total renal uptake. Captopril renoscintigraphy yielded 67% (12/18) sensitivity and 76% (19/25) specificity. The low specificity of CRS was due to the application of a prospective criterion of the captopril-induced reduction rate (CRR) of less than -20%, which was calculated from the renal uptake before and after captopril. When criteria of CRR less than -25% were used, the specificity of CRS was improved to 96%, but the sensitivity declined to 61%. Changes in the configuration of the renogram induced by captopril also had high specificity but low sensitivity. Renovascular hypertension was most likely when criteria for both CRR and the renogram were fulfilled. These criteria often were diagnostic in patients with bilateral renal artery stenosis that showed variable scintigraphic responses to captopril challenge. Captopril renoscintigraphy is a very specific means to evaluate RVH, but may have limitations in certain clinical situations such as poorly preserved function of the affected kidney, prior long-term administration of captopril, prior surgical manipulation of stenotic renal artery, and chronic renal parenchymal damage.
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PMID:Captopril renoscintigraphy with Tc-99m DTPA in patients with suspected renovascular hypertension. Prospective and retrospective evaluation. 831 97


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