Hypertension and Takayasu Disease

Abstract

Introduction: Takayasu’s disease (TD) is a primary, inflammatory, rare, segmental and multifocal arteritis of the aorta and its branches, of unknown etiopathogenesis. Hypertension is a major complication, sometimes revealing the disease, whose mechanisms are multiple, dominated by the lesion of the aorta and renal arteries. Patients and methods: We report a series of 63 cases treated for Takayasu’s disease resulting from a monocentric, retrospective study from April 2oo6- July 2014, with an average age of 30 years with a female predominance of 83%. Result: In our series: 51 patients with hypertension, including 29 (57%) resistant hypertension (under tri see quadritherapy). In 87% of cases lesion of the supra aortic trunk, 29% with aortic lesions and renal arteries, 7.93% with isolated renal arteries and 7% with aortic coarctation cases, valvular heart disease in 7% of cases. Association with tuberculosis in 7.93% of cases and a dysthyroidism in 11.1% of cases. That 49% benefited from surgical treatment. Discussion: Involvement of the aorta and renal arteries seen in half of patients with TD is the leading cause of hypertension. In general, hypertension is severe, not or poorly controlled by medical treatment and is accompanied by cardiac and renal repercussions. Conclusion: Hypertension is common during TD; it is a poor prognostic factor, more serious than the cause is renovascular. Early diagnosis and appropriate therapy will help to prevent a handicap, which is sometimes major for these patients, most of whom are young. Surgical treatment of renal and aortic lesions of TD is indicated when there is severe hypertension, not or poorly controlled by heavy medical treatment, and the indications should be weighed well. The spontaneous evolution in these patients is burdened with a not insignificant mortality. Management and therapeutic decisions must be multidisciplinary.