Abstract
Objectives The association between accessory renal artery (ARA) and hypertension remains not fully understood. We observed the association between ARA and clinical characteristics among middle-aged patients with primary hypertension. Methods One hundred and sixty-two middle-aged (mean 39.82 ± 10.25 years, 58.0% male) patients with primary hypertension were enrolled, and patients underwent Computed Tomography Angiography (CTA) of renal arteries, ambulatory blood pressure monitor (ABPM), echocardiography, physical examination, and routine blood chemistry examinations. According to the CTA results, patients were divided into a non-ARA (n = 108) and ARA (n = 54) group. Direct renin concentration (DRC), plasma aldosterone concentration (PAC), ABPM, echocardiography, creatinine, and glomerular filtration rate were compared between the two groups. Results DRC (mU/L) (11.21 (5.34, 20.87) vs. 18.24 (10.32, 33.59), P=0.002) was significantly higher in the ARA group than in the non-ARA group. However, PAC (ng/dL) (98.30 (67.30, 134.00) vs. 116.50 (78.80, 137.25), P=0.103) was similar between these two groups. ABPM (mmHg) results showed that daytime (146.75 ± 17.04/95.86 ± 11.39 vs. 155.50 ± 14.76/100.48 ± 10.69, P < 0.05), night time (133.44 ± 17.50/85.28 ± 12.80 vs. 139.81 ± 14.64/89.83 ± 11.21, P < 0.05), and 24 h blood pressure (143.95 ± 15.99/93.90 ± 11.78 vs. 152.07 ± 13.85/98.11 ± 10.36, P < 0.05) were significantly higher in the ARA group than in the non-ARA group. Accordingly, echocardiographic-derived posterior left ventricular wall thickness value was higher in the ARA group than in the non-ARA group. Conclusion ARA is related to higher blood pressure and higher direct renin concentration in middle-aged patients with primary hypertension, and these patients deserve stricter blood pressure control. Our results provide important evidence for that ARA is a cause of hypertension and target organs damages.
Highlights
Hypertension is one of the major risk factors for various cardiovascular events, such as stroke, myocardial infarction, heart failure, and chronic kidney disease [1,2,3]
The renal parenchyma served by accessory renal artery (ARA) secretes more renin than the other parenchyma served by main renal artery
Our results showed that the patients with ARA had significantly geometric changes of the myocardium and mild renal dysfunction. erefore, these results suggested that the patients with ARA should obtain stricter blood pressure control to prevent of severe cardiovascular events
Summary
Hypertension is one of the major risk factors for various cardiovascular events, such as stroke, myocardial infarction, heart failure, and chronic kidney disease [1,2,3]. An understanding of the pathophysiology of hypertension is essential to develop effective therapeutic strategy that contributes to the prevention of cardiovascular events [6]. Ere are about 22–24% hypertensive patients having accessory renal arteries (ARAs) [7, 8]. ARAs are aberrant arterial branches originating directly from the aorta and serve a small portion of renal parenchyma [9, 10]. The renal parenchyma served by ARA secretes more renin than the other parenchyma served by main renal artery. International Journal of Hypertension as a result of smaller calibre and lower perfusion pressure of ARA [11, 12]. Erefore, it is still controversial whether ARA plays a role in the pathogenesis of hypertension and the potential pathogenic mechanism underlying it Other researchers suggest that ARA is just a vascular anomaly and not a cause of hypertension [7, 15]. erefore, it is still controversial whether ARA plays a role in the pathogenesis of hypertension and the potential pathogenic mechanism underlying it
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