Renovascilar hypertension against the background of multifocal atherosclerosis: impact of endovascular methods of correction on its course and optimization of remedial measures

Abstract

The course of renovascular (resistant) arterial hypertension was analyzed in 60 patients (45 men, 15 women) with isolated atherosclerotic stenosis of the renal artery of more than 75% (group 1), and in 30 patients (26 men, 4 women) who, in addition to unilateral stenosis of the renal artery of more than 75%, also had stenoses of the brachiocephalic arteries up to 60% of the vessel diameter (group 2). The mean age of the examined patients in group 1 was 52.4 ± 6.9 years, and in group 2 it was 53.2 ± 7.4 years. Endovascular correction of hemodynamically significant stenosis of the renal artery leads to a significant decrease in systolic and diastolic blood pressure levels, a reduction in the number of antihypertensive drugs from 5-4 to a 3-component scheme in most cases, and an improvement in the functional state of the kidneys. At the end of the 2-year observation period, in patients with multifocal lesions of the renal and cerebral arteries (group 2), both systolic and diastolic blood pressure levels corresponded to “high normal” values, while in group 1 (isolated renal artery lesions) they corresponded to “normal” blood pressure levels. Patients in group 2 had metabolic disorders such as atherogenic dyslipidemia, hyperuricemia, and significant signs of renal dysfunction. The multifocal nature of atherosclerotic vascular lesions contributes to a more “severe” course of the disease, which should be taken into account when conducting treatment measures.