Diagnosis Of Renovascular Hypertension Research Articles

Interest of renal scintigraphy with captopril in the diagnosis of renovascular arterial hypertension

Introduction: Renal scintigraphy with captopril test of the kidney is a simple, non-invasive functional imaging technique that can be used to demonstrate the role of stenosis in the development of renovascular hypertension (RVH). It also makes it possible to distinguish renal artery stenosis responsible for RVH from stenosis associated with primary arterial hypertension. Objective: To illustrate the benefits of renal scintigraphy with captopril test in the diagnosis of RVH. Material and method: This was a prospective and descriptive study over a period of 12 months, from 1 March 2016 to 4 March 2017, carried out in the nuclear medicine department of the Institut des Radio Isotopes (IRI) in Niamey. The parameters studied were age, frequency, creatinemia, tracer used, relative perfusion, relative renal function and maximum uptake time. Results: We collected 6 cases presenting with either hypertension refractory to well-administered two- or three- therapy, or severe hypertension at the complication stage, or hypertension associated with hypokalaemia or unexplained renal failure or reversible renal failure induced by a conversion enzyme inhibitor. The mean age was 35 years. The age of diagnosis of hypertension ranged from 20 to 28 years. Four patients underwent echodoppler of the renal arteries: unilateral stenosis in patients A, C and F, and bilateral stenosis in patient D. The captopril test was positive in 3 cases, patients A, B and C. Conclusion: Dynamic renal scintigraphy with captopril testing is a non-invasive, low-radiation diagnostic method for the investigation of renovascular hypertension. It has a triple benefit, including the detection of the most severe arterial stenoses, the prediction of the curability of the stenosis by a revascularisation procedure and, finally, post-treatment follow-up.

RENOVASCULAR HYPERTENSION-INDUCED CARDIAC CHANGES IN A RAT MODEL: FEASIBILITY OF CONVENTIONAL AND RECENT ECHOCARDIOGRAPHY

Objective: Renovascular hypertension (RH) is a major cause of secondary hypertension, and hypertension eventually led to cardiac remodeling in patients. Hypertension leads to concentric left ventricle hypertrophy, while hypervolemia originated from renal failure leads to eccentric hypertrophy. Both mechanisms occur in RH which results in complex cardiac remodeling. Uraemic cardiomyopathy results from RH is characterized by diastolic dysfunction, but traditional echocardiography was limited in evaluating the diastolic function due to unknown hemodynamic and morphologic status. Recently, non-invasive intraventricular pressure gradient (IVPG), a preload-independent diastolic function parameter, was established and showed higher sensitivity to evaluate diastolic dysfunctions, particularly during cardiomyopathy. However, no previous studies highlighted the feasibility of the IVPG in the diagnosis of RH. Design and method: Twelve rats were received subtotal nephrectomy in 1 week to produce progressive renal failure as the RH group. The other twelve rats were sham-operated as a control group. Conventional and color M-mode echocardiography was performed for isoflurane-anesthetized rats at 2nd, 4th, 6th, and 8th weeks post-operation. IVPG was evaluated based on the Euler equation. Results: Hypertension, polyuria and hypervolemia were observed in RH group from the 2nd, 4th, and 8th week, respectively. Marked left ventricle hypertrophy was evidenced at 6th (1.32 ± 0.28 vs 1.09 ± 0.09, p = 0.016) and 8th-week post-operation (1.34 ± 0.28 vs 1.16 ± 0.09, p = 0.014) that was more prominent in the posterior papillary muscle. Peak mitral E velocity in RH rats was higher than control at the 8th week (106.35 ± 16.04 vs 91.23 ± 10.82, p = 0.031). In contrast, tissue Doppler index, total IVPG, basal IVPG, and mid-to-apical IVPG showed no difference between groups throughout the experiment. Conclusions: Hypervolemia and RH lead to unclassified geometry in RH-associated cardiac remodeling. Blood pressure change precedes the change of preload during the development of RH cardiac remodeling.

A simple, refined approach to diagnosing renovascular hypertension in children: A 10-year study.

Despite advances in non-invasive vascular imaging, detection of renal artery stenosis via catheter angiography is the criterion standard for the diagnosis of renovascular hypertension (RVH). However, because of lack of evidence, the utility of various blood tests and imaging modalities remains unclear. We retrospectively analyzed the utility of blood tests (plasma renin activity [PRA], aldosterone, and renal vein renin[RVR] values) and imaging studies (computed tomography angiography [CTA], kidney ultrasonography[US]) by comparing them with catheter angiography. Ten pediatric patients with RVH at two institutions from January 2008 to December 2017 were recruited. The sensitivities for diagnosing RVH via imaging and blood tests (kidney [US], PRA, and aldosterone) were derived by examining patient records. Furthermore, the sensitivity and specificity of CT angiography were calculated by considering both the affected and non-affected renal arteries of the patients. A high sensitivity for diagnosing RVH via kidney US(89%) and PRA (80%) was observed. The sensitivity and specificity of CTA were 100%, each. RVR sampling did not aid in the diagnosis of RVH; only two of six patients with unilateral RVH showed significant laterality of RVR boundary ratios. Renal scintigraphy facilitated detection of a non-functional kidney (split renal function <5%). RVH in children could be diagnosed utilizing non-invasive blood and imaging tests, without catheter angiography. We recommend kidney length measurement along with measurement of PRA level, as a simple and highly useful screening test, followed by CTA as a diagnostic test.

Case report: secondary hypertension in a 6-year old child with bilateral renal artery stenosis

Background. Renovascular hypertension (RVH) is an elevated blood pressure caused by partial or complete occlusion of one or both renal arteries or their branches. According to different studies, renal artery stenosis accounts for 5–10% of all cases of hypertension in children. The most common causes of renal artery stenosis are deemed to be atherosclerosis and fibromuscular dysplasia.Case description. The article describes clinical case of a newly diagnosed renovascular hypertension amid background of fibromuscular dysplasia of renal arteries in a 6-year old child, particulars of the clinical course, laboratory and instrumental methods of investigation and treatment including aortography and balloon angioplasty of renal arteries.Conclusion. This case report illustrates that in the absence of complaints and pronounced clinical symptoms the diagnosis of renovascular hypertension in a 6-year old child could not be established for a long time. Timely detection of elevated BP in children, including the young ones, not only during visiting specialist physicians but also during prophylactic examination by pediatrician, is required for early diagnosis of the disease and development of the examination and treatment strategy.

Value of non-contrast-enhanced MR angiography combined with captopril renal scintigraphy in the diagnosis of renovascular hypertension

Objective To evaluate the clinical value of non-contrast-enhanced MR angiography (NCE-MRA) combined with captopril renal scintigraphy (CRS) in the diagnosis of renovascular hypertension (RVH). Methods A total of 52 patients (33 males, 19 females; age: (54.5±16.3) years) with highly suspected RVH between January 2018 and October 2018 from Henan Provincial People′s Hospital were retrospectively analyzed. The examination data of NCE-MRA, basic renal dynamic imaging, CRS and digital subtraction angiography (DSA) were collected and reviewed. The renal artery stenosis (RAS) rate≥70% was the criterion for RVH diagnosed by DSA, which was considered as the gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of NCE-MRA, CRS and NCE-MRA+ CRS were determined. The consistency between NCE-MRA and DSA was analyzed by Kappa test. The differences of diagnostic efficiencies between CRS and NCE-MRA + CRS were compared by χ2 test or Fisher exact test. Results There was a high consistency between NCE-MRA and DSA in the diagnosis of RVH (Kappa=0.81, 95% CI: 0.62-0.96; P<0.01). The diagnostic sensitivity, specificity, accuracy, PPV and NPV of NCE-MRA were 88.89%(24/27), 92.00%(23/25), 90.38%(47/52), 92.31%(24/26), and 88.46%(23/26) respectively, those of CRS were 81.48%(22/27), 72.00%(18/25), 76.92%(40/52), 75.86%(22/29) and 78.26%(18/23) respectively, and those of NCE-MRA+ CRS were 74.07%(20/27), 100%(25/25), 86.54%(45/52), 100%(20/20) and 78.12%(25/32) respectively. Compared with CRS, the specificity (P=0.01) and PPV (P=0.03) of NCE-MRA+ CRS in the diagnosis of RVH were increased. Conclusion NCE-MRA and CRS are effective in the diagnosis of RVH, and the combination of two methods can significantly improve the diagnostic specificity and PPV than CRS alone. Key words: Hypertension, renovascular; Radionuclide imaging; Captopril; Technetium Tc 99m pentetate; Magnetic resonance imaging

Treatment of severe hypertension in a 14-year-old child: Successful blood pressure control with additive administration of captopril, an angiotensin-converting enzyme inhibitor, in a patient with bilateral renovascular hypertension

ABSTRACTWe report a 14-year-old boy with recurrent episodes of headache caused by uncontrolled hypertension. The diagnosis of renovascular hypertension due to Takaysu arteritis (TA) was made based on an increase in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and computed tomography (CT) image of bilateral renal artery stenosis was taken. Renal scintigraphy revealed normal perfusion and function of the right kidney and severe reduction of the perfusion and function of the left kidney. Careful drug adjustments significantly improved but did not fully control the blood pressure (BP); further, angioplasty, which showed almost occlusion of the left renal artery opening and the minor narrowing of the right renal artery, failed to regain sufficient BP control. The addition of captopril, an angiotensin-converting enzyme (ACE) inhibitor, to conventional antihypertensive drugs successfully and safely lowered BP and preserved the renal function. This unique case suggested that ACE inhibitors achieved better control of BP in a patient with bilateral renal stenosis and that the patient may have hemodynamically significant stenosis caused by unilateral renal artery.

Determination of effect of aspirin and captopril on cat glomerular filtration rate using renovascular hypertension scintigraphy

Purpose: To compare the effects of aspirin and captopril on glomerular filtration rate (GFR) during renal perfusion scintigraphy in cats after experimentally-induced unilateral renal-artery stenosis.Methods: Twenty mixed-breed adult cats weighing 3-4 kg were used. After conducting renal scintigraphy operations, their GFRs were measured by the method of Gate. Four days later, renovascular hypertension was induced through renal-artery stenosis by clipping half of the left renalarteries. Renal scintigraphy was conducted after four days. After confirming the presence of hypertension, the cats were divided into two groups of 10 animals each (aspirin and captopril groups, respectively). The drugs were administered orally to the groups. One hour later, scintigraphic operations were repeated under anaesthesia after injecting 2 mCi of the radiopharmaceutical, technetium-99m diethylene triamine pentaacetic acid (99mTc-DTPA), via the femoral vein as a bolus dose. In all groups, regions of interest (ROIs) were drawn and GFRs were measured by Gate method.Results: Mean total GFR (both right and left kidneys) in operated animals treated with captopril was 5.459 ml/min while the mean value for the left kidney and right kidneys were 1.585 and 3.874 ml/min, respectively. In operated animals treated with aspirin, mean total GFR was 5.440 ml/min, while the values for the left kidney and right kidneys were 1.567 and 3.866 ml/min, respectively.Conclusion: These results indicate that aspirin has similar reduction effect on GFRs and similar shape of renograms as captopril in cat renovascular hypertension scintigraphy. Thus, aspirin is a suitable substitute for captopril in the diagnosis of renovascular hypertension in renal scintigraphy.Keywords: Aspirin, Captopril, Cat, Renovascular Hypertension, Scintigraphy

Non-invasive imaging cannot replace formal angiography in the diagnosis of renovascular hypertension.

Renovascular disease (RVD) is found in about 10% of secondary childhood hypertension. Digital subtraction angiography (DSA) is the gold standard to diagnose RVD. Non-invasive imaging methods like Doppler ultrasound (US), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) are increasingly used. Our aim was to evaluate the role and accuracy of US, MRA, and CTA compared to DSA in diagnosing RVD in children. A retrospective review of 127 children with suspected renovascular hypertension was performed in children referred to Great Ormond Street Hospital between 2006 and 2014 due to clinical suspicion of renovascular hypertension and/or findings on US and/or MRA or CTA. Ninety-nine of 127 children (78%) were diagnosed with renovascular disease and 80 were treated with percutaneous transluminal angioplasty during the same procedure. The median age at presentation was 5.6 (range, 2.5-10.6) years. Thirty-six children had unilateral renal artery stenosis in major extraparenchymal vessels, 47 bilateral stenosis and 16 intrarenal small vessel disease. US had a sensitivity of 63% and specificity of 95%. MRA and CTA were performed in 39 and 34 children, respectively. CTA sensitivity was slightly higher than that of MRA, 88 vs. 80%, and specificity 81 vs. 63%. The sensitivity of MRA and CTA is still too low to reliably rule out renovascular disease in children with a strong suspicion of this diagnosis. DSA remains the gold standard to diagnose renovascular hypertension and is recommended when clinical and laboratory criteria are highly suggestive of renovascular disease even with normal radiological investigations from non-invasive methods.

Diagnosis of renovascular hypertension by repeated measurement using multiple modalities

Diagnosis of renovascular hypertension by repeated measurement using multiple modalities

Pediatric renovascular hypertension in Thailand: CT angiographic findings

Renovascular disease is an uncommon but important cause of hypertension in children. When unrecognized and untreated, renovascular hypertension in children can have serious complications. To review the causes of renovascular hypertension and computed tomography angiographic (CTA) findings in children and adolescents. Twenty-eight CTAs from January 2004 to March 2008 of 23 children and adolescents with hypertension were reviewed for the causes and CTA findings. Nine of the 23 children (39%) had abnormal renal arteries with or without abnormal abdominal aortas. Four of these children had Takayasu arteritis, one had moyamoya disease, and one had median arcuate ligament syndrome. One with chronic pyelonephritis had severe stenosis of the proximal right renal artery. The other two children had renal artery stenosis with a nonspecific cause. One child with a normal abdominal aorta and renal arteries had a right suprarenal mass. On pathological examination a ganglioneuroma was found. CTA can help in diagnosis of renovascular hypertension in children and adolescents. Although CTA is not a screening modality, it is appropriate in some situations.

Metabolic alkalosis and sodium-induced hypokalemia in the diagnosis of renovascular hypertension

Metabolic alkalosis and sodium-induced hypokalemia in the diagnosis of renovascular hypertension

Prevalence and predictors of renal artery stenosis in patients with coronary artery disease

Background Renal artery stenosis (RAS) is an important clinical entity that can lead to uncontrolled hypertension and progressive renal failure. The most common causes of RAS are atherosclerosis and fibromuscular dysplasia. Because the diagnosis of renovascular hypertension is established only when revascularization of a stenosed renal artery results in cure or improvement in patients hypertension, establishment of a causal relationship between RAS and hypertension continues to present a challenge. Therefore, a high index of suspicion is essential in the diagnosis of this condition. Methods Multiple tests, both invasive and noninvasive, are available as screening methods. Angiography remains the gold standard for diagnosis of RAS. Besides its value in establishing the diagnosis, it provides anatomic information regarding the site and severity of stenoses and appropriate revascularization strategies. Magnetic resonance angiography and duplex ultrasonography are the most promising and accurate noninvasive screening tests available, even in the presence of renal insufficiency. With advances in percutaneous transluminal angioplasty techniques, including renal artery stenting, many more patients are eligible for less invasive and effective revascularization strategies compared with the traditional surgical procedures. Results Revascularization of a stenosed renal artery is associated with preservation of renal function and better control of hypertension, unstable angina, and congestive heart failure. Because atherosclerotic RAS is associated with generalized atherosclerosis, aggressive risk factor modification and antiplatelet therapy are integral in the management of RAS regardless of the revascularization strategy. (Am Heart J 2002;143:559-64.)

Endocrine and nuclear medicine diagnosis of renovascular hypertension

To check the reliability of the captopril test and of quantitative radioisotope techniques for the primary diagnosis of renovascular hypertension the data from 41 patients suspected of this disease were retrospectively analysed. In all cases plasma renin activity (PRA) was assayed in peripheral blood and in renal vein blood before and after 25 mg captopril. Double tracer studies with 131I-hippuran and 99mTc-DTPA were also performed, as was renal arteriography. The postoperative blood pressure plots of 23 patients with unilateral renal artery stenosis (who had subsequently been operated upon) were included in the evaluation. Renovascular hypertension was diagnosed in 21 patients and essential hypertension in 20. Twelve of the 20 patients with essential hypertension had renal artery stenosis, but this had not produced renovascular hypertension. The diagnostic significance of the tests as markers of renovascular hypertension was as follows: captopril test P less than 0.001, glomerular filtration fraction P less than 0.02, hippuran clearance P less than 0.001. The captopril test and the quantitative radioisotope techniques were in agreement in identifying patients with renal artery stenosis and renovascular hypertension. False-positive results due to methodological shortcomings can be avoided by applying both methods in succession.

Reno-vascular hypertension in childhood: a nationwide survey

Renovascular disease accounts for 8-10% of all cases of paediatric hypertension, whereas, in adults, its incidence is approximately 1%. The Turkish Paediatric Hypertension Group aimed to create the first registry database for childhood renovascular hypertension in Turkey. Twenty of the 28 paediatric nephrology centres in Turkey responded to the survey and reported 45 patients (27 girls, 18 boys) with renovascular hypertension between 1990 and 2005. The age at presentation ranged from 20 days to 17 years. The mean blood pressure at the diagnosis was 169/110 mmHg. Chief complaints of symptomatic patients were headache (38%), seizure (18%), epistaxis (4%), growth retardation (4%), cognitive dysfunction (4%), polyuria (2%), palpitation (2%), and hemiplegia (2%). Renovascular hypertension was found incidentally in 11 children. The diagnosis of renovascular hypertension was established with conventional angiography in 39 patients, MR angiography in three, CT angiography in two, and captopril diethylene triamine penta-acetic acid (DTPA) scintigraphy in one patient. Twenty-one children had bilateral renal artery stenosis and 24 had unilateral renal artery stenosis. Of these, 14 (31%) had fibromuscular dysplasia; 12 (27%) Takayasu's arteritis; six (13%) neurofibromatosis; two (5%) Williams syndrome; one (2%) Kawasaki disease; one (2%) mid-aortic syndrome; one (2%) extrinsic compression to the renal artery, and eight (18%) unspecified bilateral renal artery stenosis. Hypertension was controlled with antihypertensive drugs in 17 patients. Percutaneous transluminal angioplasty (PTRA) or surgery had to be performed in 28 patients: PTRA in 16 patients, PTRA + surgery in one patient and surgery in 11 patients (four nephrectomies). The importance of vasculitic disease, especially Takayasu's arteritis, should not be underestimated in children with renovascular hypertension.

Is Incidental Renal Arteriography Justified in a Population of Patients with Symptomatic Peripheral Arterial Disease?

Renal artery stenosis is a consequence of generalized atherosclerosis and many specialists perform routine selective renal angiography to detect and treat renal artery stenosis. The incidence of clinically important renal artery stenosis is not well defined in patients with symptomatic peripheral arterial disease. The purpose of this study was to better delineate the incidence of and the risk factors associated with renal artery stenosis, renovascular hypertension, and ischemic nephropathy incidentally discovered during angiography for symptomatic peripheral arterial disease. Two hundred consecutive patients undergoing angiographic evaluation of symptomatic lower extremity peripheral arterial disease were studied retrospectively. Angiograms were reviewed for the presence of renal artery stenosis (defined as >or= 25% diameter reduction in either renal artery) and findings were then correlated to the clinical diagnosis of renovascular hypertension (> 50% renal artery stenosis and >or= 3-drug resistive hypertension) and ischemic nephropathy (defined as > 50% bilateral renal artery stenosis, 3-drug hypertension, and creatinine >or= 1.5). Angiographic findings were also correlated with risk factors to determine if a relationship correlated to the presence of and degree of renal artery stenosis. Data were analyzed using the Student's t test, Chi-square model, and multiple logistic regression analysis. The overall incidence of any degree of renal artery stenosis in this study population was 26% (52 patients). Only 24 (12%) patients had an incidental finding of >or= 50% stenosis in either renal artery. Six (3%) of these patients were found to have associated renovascular hypertension. Additionally, 9 (4.5%) patients had coexistent renal insufficiency and significant renal artery stenosis; five with end-stage renal disease on chronic hemodialysis. Only one patient with end-stage renal disease had poorly controlled 3-drug hypertension. Thus definitive ischemic nephropathy was present in only one (0.5%) patient. Statistically significant risk factors associated with the presence of renal artery stenosis include hypertension (P < .001), coronary disease (P = .024), female gender (P = .010), diabetes (P = .039), aorto-iliac disease (P = .031), multiple levels of peripheral arterial disease (P < .001), and age over 60 ( P < .001). While the incidence of renal artery stenosis in patients being evaluated for symptomatic peripheral arterial disease is similar to that reported in the cardiology literature, the incidence of renovascular hypertension and ischemic nephropathy is exceedingly low (3% and 0.5%, respectively)-findings similar to data reported in the general hypertensive population. These data suggest that incidental selective renal angiography is not justified in patients with symptomatic peripheral arterial disease.

Report of a case with surprising etiology of renovascular hypertension

Takayasu arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its main branches. Epidemiologically, it is found mostly in female patients and is more prevalent in Asian and Latin American countries. Disease may be heterogeneous in presentation. In this report, we present a different clinical expression of Takayasu arteritis in a young man who had hypertension as the sole manifestation of multiple critical arterial involvement with elevated inflammation markers but no other symptoms. A 28-year-old man was admitted with hypertension. There was no evidence for systemic vasculitis by history, serologic studies or other laboratory data. The acute-phase reactants were elevated with an erythrocyte sedimentation rate of 55 mm/h, and a C-reactive protein value of 22 mg/dl. Digital subtraction angiography showed multiple severe stenoses or occlusions of the branches of the abdominal aorta and arcus aortae together with bilateral renal artery involvement. The etiology of renovascular hypertension was found to be Takayasu arteritis with the presence of at least three criteria, as outlined by the American College of Rheumatology in 1990. Patients with Takayasu arteritis may have atypical clinical expression of the disease, and a diagnosis of Takayasu arteritis should be kept in mind in the differential diagnosis of renovascular hypertension in young subjects, even if they do not have associated symptoms of multiple arterial involvement.

Renal artery stenosis: A cardiovascular perspective

Background Renal artery stenosis (RAS) is an important clinical entity that can lead to uncontrolled hypertension and progressive renal failure. The most common causes of RAS are atherosclerosis and fibromuscular dysplasia. Because the diagnosis of renovascular hypertension is established only when revascularization of a stenosed renal artery results in cure or improvement in patients hypertension, establishment of a causal relationship between RAS and hypertension continues to present a challenge. Therefore, a high index of suspicion is essential in the diagnosis of this condition. Methods Multiple tests, both invasive and noninvasive, are available as screening methods. Angiography remains the gold standard for diagnosis of RAS. Besides its value in establishing the diagnosis, it provides anatomic information regarding the site and severity of stenoses and appropriate revascularization strategies. Magnetic resonance angiography and duplex ultrasonography are the most promising and accurate noninvasive screening tests available, even in the presence of renal insufficiency. With advances in percutaneous transluminal angioplasty techniques, including renal artery stenting, many more patients are eligible for less invasive and effective revascularization strategies compared with the traditional surgical procedures. Results Revascularization of a stenosed renal artery is associated with preservation of renal function and better control of hypertension, unstable angina, and congestive heart failure. Because atherosclerotic RAS is associated with generalized atherosclerosis, aggressive risk factor modification and antiplatelet therapy are integral in the management of RAS regardless of the revascularization strategy. (Am Heart J 2002;143:559-64.)

The effect of patients' race and health insurance status on the use of renal artery angiography for patients with a diagnosis of renovascular hypertension

The effect of patients' race and health insurance status on the use of renal artery angiography for patients with a diagnosis of renovascular hypertension

ACUTE ABDOMINAL SYMPTOMS IN MALIGNANT HYPERTENSION: CLINICAL PRESENTATION IN FIVE CASES

Malignant hypertension causes anatomical and functional damage in several target organs, in particular brain, retina, heart and kidneys. Although vascular lesions in the gastroenteric tract are known to occur in several instances, their clinical relevance is unknown.In this study five cases of malignant hypertension, presenting with acute abdominal symptoms, are reported. A history of essential arterial hypertension was present in three patients; while one patient had a previous diagnosis of renovascular hypertension and one patient had renoparenchymal hypertension. However, in all cases the antihypertensive treatment was discontinued and inadequate before the accelerated malignant phase. The acute abdominal symptoms at presentation were due to intestinal infarction in 3 patients and acute pancreatitis in 2 patients. One patient with intestinal infarction died of postoperative cardiogenic shock. Our data are in agreement with previous reports describing the possible intra-abdominal complications of malignant hypertension. The therapeutic approach in such conditions should always consider an effective antihypertensive treatment in conjunction with surgical options.

Captopril renography and duplex Doppler sonography in the diagnosis of renovascular hypertension

Captopril renography and duplex Doppler sonography in the diagnosis of renovascular hypertension