Renovascular Hypertension Research Articles

Diagnosis and treatment of pediatric arterial stenosis associated with neurofibromatosis type 1

BackgroundNeurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder affecting multiple systems. However, arterial stenosis is a rare manifestation in patients with NF1. Since the symptoms of arterial stenosis caused by NF1 are often atypical and have a high under-diagnosis rate, this can lead to serious complications such as hypertension, ischemic stroke, or even death. The aim of our research is to analyse the clinical characteristics of arterial stenosis in pediatric patients with NF1 and to summarise its diagnosis, treatment and prognosis.MethodsWe conducted a retrospective review of data from patients with NF1 treated at Beijing Children’s Hospital from 2016 to 2020. Patients diagnosed with arterial stenosis, identified through clinical symptoms, physical examination, arterial ultrasonography, or imaging studies, were included in this study. These patients received symptomatic drug and/or surgical treatments and were followed up regularly. We summarized demographic characteristics, sites of arterial stenosis, clinical manifestations, and treatment outcomes.ResultAmong the 258 patients with NF1 treated at our hospital, 12 (4.7%) had arterial stenosis, comprising 9 males and 3 females with a median age of 7 years (range: 1–14 years). Renal artery stenosis was diagnosed in 7 patients (58.3%), while internal carotid artery (ICA) stenosis was diagnosed in 5 patients (41.7%). The predominant symptoms of renal artery and ICA stenosis were renal hypertension and convulsions, respectively. Antihypertensive drugs were effective in 5 patients with renal hypertension; 2 patients required balloon dilatation of the renal artery due to inadequate response to medication. Oral antiepileptic treatment was effective in 3 patients with ICA stenosis, and encephaloduroarteriosynangiosis was effective in the remaining 2 cases. The follow-up period ranged from 2 to 6 years, with a median duration of 3 years. No deterioration or mortality was observed during the follow-up period.ConclusionsArterial stenosis was present in approximately 4.7% of patients with NF1, predominantly affecting the renal artery and ICA. Renal hypertension and convulsions were the primary symptoms of renal artery and ICA stenosis, respectively. Early diagnosis and intervention can substantially improve the prognosis of these patients.

A case of renovascular hypertension due to polyarteritis nodosa.

In renal vasculitis, luminal narrowing can reduce blood flow and activate the renin-angiotensin-aldosterone system, causing renovascular hypertension. We present the case of a 47-year-old man with previous intestinal tuberculosis and episodes of lumbar pain, tender erythematous nodules and arthralgias. He had grade 3 hypertension, unresponsive to treatment, with left ventricular concentric hypertrophy and chronic kidney disease. He was admitted to the ICU due to a hypertensive emergency, with acute kidney failure and a large peri-renal hematoma. The computed tomography and angiography showed bilateral renal scarring, intrarenal pseudoaneurysms and irregularities in the renal, common hepatic and mesenteric arteries, suggesting a medium-vessel vasculitis, namely polyarteritis nodosa. Cyclophosphamide and corticosteroids were started. His blood pressure was controlled, and his kidney function remained stable. Renovascular hypertension is, in infrequent cases, caused by an inflammatory systemic disease. When this is the case, the diagnosis must be considered and appropriately addressed.

Mesenchymal Stem/Stromal Cells Reverse Adipose Tissue Inflammation in Pigs with Metabolic Syndrome and Renovascular Hypertension.

Metabolic syndrome (MetS) is associated with low-grade inflammation, which can be exacerbated by renal artery stenosis (RAS) and renovascular hypertension, potentially worsening outcomes through pro-inflammatory cytokines. This study investigated whether mesenchymal stem/stromal cells (MSCs) could reduce fat inflammation in pigs with MetS and RAS. Twenty-four pigs were divided into Lean (control), MetS, MetS + RAS, and MetS + RAS + MSCs. In the MSC-treated group, autologous adipose-derived MSCs (107 cells) were injected into the renal artery six weeks after RAS induction. After four weeks, fat volumes and inflammatory markers were assessed. MSC treatment reduced levels of pro-inflammatory cytokines (MCP-1, TNF-a, IL-6) in the renal vein blood and in perirenal fat. The MSCs also decreased fat fibrosis, restored adipocyte size, and altered adipogenesis-related gene expression, particularly in the perirenal fat. These effects were less pronounced in subcutaneous fat. The MSC therapy attenuated fat inflammation and improved metabolic outcomes in pigs with MetS + RAS, suggesting that adipose-derived MSCs may offer a promising therapeutic approach for metabolic disorders.

Complex equilibrium involving aldosterone underlies the pathophysiology of renovascular hypertension.

The mechanisms underlying the maintenance of hypertension in renovascular hypertension (RVH) are not well understood. To test the current concept of RVH pathophysiology, circulating aldosterone levels in clinical cases were investigated through a literature survey of pediatric cases. Fifty-four patients with documented aldosterone levels were identified. Of these, 42 patients (78%) were assigned to the high renin (HR) group and the rest to the low-normal renin (LR) group. Patients in the HR group were more likely to have unilateral lesions (35/42) than those in the LR group (6/12). In the LR group (corresponding to volume-dependent RVH), 50% (6/12) of patients had elevated aldosterone levels, indicating that the equilibrium between renin and aldosterone shifted towards aldosterone dominance. In the HR group (corresponding to renin-dependent RVH), aldosterone levels were much higher, with 76% (32/42) of patients exceeding the reference range and 14 patients developing hypokalemia. These results are consistent with the notion that pressure natriuresis allows continuous aldosterone action in renin-dependent RVH. In conclusion, the aldosterone status observed in the clinical cases is in agreement with the current understanding of the pathophysiology of RVH, in which a complex equilibrium state involving renin, angiotensin-II, pressure natriuresis, and aldosterone exists.

Molecular hydrogen reduces mean and systolic blood pressure in various forms of hypertension, as well as inflammatory processes in lung tissue, in Wistar rats

Molecular hydrogen demonstrates antioxidant and anti-inflammatory properties. It has been shown to have a protective effect in several cardiovascular diseases. The aim of this work was to study the effect of breathing atmospheric air containing 4% hydrogen on the degree of development of monocrotaline-induced pulmonary hypertension and associated lung tissue inflammation, as well as the severity of renovascular hypertension in Wistar rats. Methods. Monocrotaline-induced pulmonary hypertension (MCT-PH) was used as a model of small circle hypertension. Three groups of animals were used in the experiment: "Control" – animals injected with monocrotaline solvent, "MCT-Control" and "MCT-H2" – groups injected with MCT once. The "Control" and "MCT-Control" groups breathed atmospheric air for 21 days, and the "MCT-H2" group breathed air containing 4% hydrogen. Inhalations were kept constant until 21 days. On day 21, haemodynamic parameters were measured under urethane anesthesia and lung samples were fixed for subsequent morphological analysis. Renovascular hypertension 1R1С (RVH) was used as a model of systemic hypertension. There were two groups in the experiment: RVH-C – rats breathed atmospheric air and RVH-H2 rats breathed air containing 4% hydrogen. During the experiment, systolic blood pressure (SBP) was measured and renal excretory function was assessed. On day 28, haemodynamic parameters were measured under urethane anesthesia. Results. In the MCT model, hydrogen had no effect on the haemodynamic symptoms of MCT hypertension, but decreased mean blood pressure (MBP), SBP and the measured markers of connective tissue remodeling in the lungs, TGF-β and MMP-9, and resulted in decreased tryptase secretion and mast cell counts. In the RVG model, hydrogen breathing decreased MBP, SBP and had no effect on renal excretory function. Conclusion. Inhalation of 4% hydrogen reduces systemic MBP and SBP in both models of arterial hypertension, reduces the severity of the inflammatory process, regulates the phenotypic and functional status of mast cells and inhibits the activity of profibrotic factors in lung tissue in MCT-PH. It is likely that the central action of hydrogen is combined with its anti-inflammatory and anti-fibrotic effects.

Pattern of Anemia in Patients with Heart Failure in Ischemic Heart Disease

Background: Anemia is common health problem encountered in patients with heart failure which in turn is is one of the common presenting feature of ischemic heart disease.This study aims to study the patterns and types of anemia in patients admitted with heart failurein ischemic heart disease. Methods: A cross sectional hospital based study for one year in eligible patients as ischemic heart disease in clinical heart failure. Blood parameters especially RBC indices, biochemical parameters including iron profile, serum ferritin, vitamin B12,folic acid were studied. Results: Out of 77 patients with mean age 67±7 years, anemia was common in female (63.6%) and elderly (66.2%). Other most common precipitants of heart failure in anemia were recent MI (<1 month) 55.8% and renal disease (55.8%), hypertension (49.4%) and diabetes (42.9%). Most common pattern of anemia according to RBC indices were normocytic (60.3%), hypochromic (79.3%), normocytic hypochromic anemia (48.2%) Iron deficiency was found in 25 (33.7%) of which absolute iron deficiency was in 12 (16.2%) and relative iron deficiency 13 ( 17.5%). Anemia of chronic disease were in 24 (32.4%), vitamin B12 deficiency 15 (20.2%) and Folic acid deficiency in 2 (2.7%). Conclusion: In heart failure with ischemic heart disease patient, anemia is common precipitating factor. Normocytic and hypochromic pattern are the commonest pattern. Iron deficiency is the commonest. Timely detection and management of iron deficiency may prevent heart failure even in ischemic heart disease.

Posterior reversible encephalopathy syndrome after COVID-19 in a patient with chronic renal failure

A 61-year-old man with chronic renal failure had an embolic stroke of undetermined source that was treated with warfarin. Five weeks later, the patient contracted coronavirus disease (COVID-19). Six days after the onset of COVID-19, high blood pressure (>200 ‍mmHg) and consciousness disturbance were reported. CT demonstrated symmetrical hypodensity areas in the bilateral cerebellar hemispheres. MRI revealed hyperintensity lesions in the bilateral cerebellar hemispheres and pons on the T2-weighted and fluid-attenuated inversion recovery images. Moreover, cerebellar lesions appeared as hyperintensity areas on apparent diffusion coefficient mapping. Based on these findings, a diagnosis of posterior reversible encephalopathy syndrome (PRES) was made. The patient was treated with antihypertensive drugs, and the consciousness level improved gradually. MRI after one month showed that the lesions had disappeared. PRES should be considered if the brain CT of patients with COVID-19 shows a low-density lesion, especially in patients with risk factors for PRES such as chronic renal failure or hypertension.

Kalanchoe crenata Andrews (Haw.) Improves Losartan's Antihypertensive Activity.

Cardiovascular diseases constitute one of the leading causes of morbidity and mortality worldwide. Herbal medicines represent viable alternatives to the synthetic drugs currently employed in the control of hypertension. This study aimed to isolate and identify the chemical markers of Kalanchoe crenata and to investigate the antihypertensive and anti-matrix metalloproteinase (MMP2) activities of an aqueous extract of the leaves. The main constituents of the aqueous extract of K. crenata were separated by ultra-performance liquid chromatography-mass spectrometry, and their presence was identified by NMR spectroscopy. Renovascular hypertension was induced in male Wistar rats using the two-kidney one-clip method (HTN groups), while control animals (Sham groups) were submitted to Sham surgery. Six groups of 10 animals each were treated daily for eight weeks as follows: Sham 1 (carrier), Sham 2 (K. crenata extract), HTN.1 (carrier), HTN.2 (K. crenata extract), HTN 3 (losartan), and HTN 4 (K. crenata extract with losartan). The main compounds of the extract were patuletin 3-O-(4″-O-acetyl-α-L-rhamnopyranosyl)-7-O-(3‴-O-acetyl-α-L-rhamnopyranoside) (1), patuletin 3-O-α-L-rhamnopyranosyl-7-O-L-rhamnopyranoside (2), and trans-caffeoyl-malic acid (3), with compounds 1 and 2 being chemical markers of the species. Significant reductions (p < 0.05) in systolic blood pressure and MMP2 (72kDa isoform) activity were observed in the HTN 4 group. The association of K. crenata extract and losartan presented in vivo effects against hypertension.

Neurofibromatosi e ipertensione arteriosa: alla ricerca della causa

The paper describes the case of a 6-year-old girl with neurofibromatosis type 1 (NF1) who was diagnosed with significant arterial hypertension during a routine check-up. After initial ineffective therapy and inconclusive investigations, an angio-CT revealed renal artery stenosis. Ballooning treatment improved blood pressure control. The case highlights the importance of monitoring blood pressure in NF1 patients and investigating suspected renovascular hypertension.

Correlation Between BMI and Kidney Tumor Lateralization: Insights into Survival and Risk Factors.

Background: Kidney cancer accounts for approximately 2% of all diagnosed cancers and fatalities worldwide, and a notable increase in its incidence has been observed in recent years. Previous studies have identified various risk factors for renal cell carcinoma (RCC), including age, gender, smoking, hypertension, overweight, and obesity. However, limited information is available regarding the correlation between RCC risk factors and tumor lateralization. Objectives: To investigate the relationship between body mass index (BMI) and the lateralization of kidney tumors in patients undergoing surgery for renal cell carcinoma. Moreover, we aim to evaluate the impact of lateralization of malignant kidney tumors on overall survival (OS) and cancer-specific survival (CSS). Materials and Methods: This single-center study included 287 patients who underwent surgical treatment for kidney tumors between January 2016 and December 2019. The patients were allocated into the following groups based on their BMI: normal (18.5-24.99 kg/m2), overweight (25-29.99 kg/m2), or obese (≥30 kg/m2). The study collected demographic and histopathological data, as well as patient history, including risk factors such as smoking and hypertension. Results: Right-sided kidney tumors occurred more frequently (55.05%, n = 158) than left-sided ones (44.95%, n = 129). A statistically significant relationship (p = 0.04731) was observed between BMI and the frequency of right-sided kidney tumors in the overweight group (70 vs. 43 cases). There was no correlation between BMI and the occurrence of kidney tumors in the normal BMI and obesity groups. Furthermore, the analysis revealed no association between the lateralization of kidney tumors, smoking, and hypertension. The 5-year survival rate was 62%, with a mean follow-up duration of 104 months (approximately 8.5 years). No statistically significant difference was observed between the right- and left-sided cancer groups, with survival rates of 58% and 66%, respectively (p = 0.652). Conclusions: This study highlighted that right-sided kidney tumors occurred significantly more frequently in overweight individuals in our cohort of patients. No association was observed between lateralization of kidney cancer and overall survival (OS) or cancer-specific survival (CSS).

Modern Open Surgery for Coral Reef Aorta with Visceral Artery Involvement.

Coral reef atherosclerosis of the visceral aorta (CRA) is associated with renovascular hypertension (RVH), chronic mesenteric ischaemia (CMI), and malperfusion of the lower limbs (PAD). The outcomes of open surgery for this rare disease are described in this paper. This retrospective study included all patients who underwent open surgical repair of CRA at a single high volume referral centre between January 2009 and June 2023. The operation was preceded by pre-operative computerised tomography angiography (CTA). Follow up was carried out to assess clinical improvement regarding walking, blood pressure control, visceral and renal ischaemia. Post-operative survival and patency of the aorta and revascularised visceral arteries were evaluated by the Kaplan-Meier method. Thirty eight patients, with a mean age of 65 years and predominantly women (57.9%), were included in the study. The surgical indication was RVH in 40.6%, CMI in 25%, and PAD in 71.9% of patients. All procedures were performed by left lumbotomy, with re-implantation or visceral/renal artery bypass in 15 patients (39.5%) and 17 (44.7%) cases of simultaneous infrarenal aortic revascularisation. One death (2.6%) secondary to acute mesenteric ischaemia occurred post-operatively. Three patients (7.9%) presented with myocardial infarction and 11 (28.9%) with post-operative acute kidney failure without haemodialysis. Median follow up was 32.5 months. Post-operatively, all patients with CMI and claudication became asymptomatic, and 17 (56.7%) showed improved hypertension. Six patients needed repeat visceral artery revascularisation. No death related to CRA occurred during follow up. Survival rates were 91.9% and 61.6% at one and five years, respectively. Visceral aortic endarterectomy by left sided lumbotomy, preceded by multiplanar reconstruction CTA is a safe and effective procedure for CRA, with low operative mortality and acceptable morbidity rates. Long term clinical monitoring by colour duplex scan or CTA is recommended due to a risk of restenosis of endarterectomised visceral arteries.

Reproducible and stable surgical hypertension using a smaller renal artery clip model in Wistar rats

Animal models of hypertension are crucial for studying the pathophysiology of diseases and developing new treatments. This study introduces a reproducible technique for inducing surgical renovascular hypertension in rats using a smaller renal artery clip. The surgical groups were compared to the control group and standard drug group to assess the effectiveness of the surgical model and its stability for 21 days. The results revealed a progressive increase in systolic and diastolic blood pressure in the surgical group. Moreover, the heart rate and body weight in the renal hypertension group demonstrated a sustained elevation at the end of 21 days. These findings confirm the efficacy of this surgical model in inducing hypertension. This surgical animal model is helpful for studying physiological parameters for investigating potential therapeutic interventions against hypertensi

Value of 24-hour urinary aldosterone in diagnosis and classification of primary hyperaldosteronism

Objective: To investigate the clinical application value of 24-hour urinary aldosterone(UEA) in diagnosis and classification of primary aldosteronism(PA). Methods: A retrospective analysis was conducted on 282 hypertensive patients admitted to the Endocrinology Department of Xiangya Third Hospital of Central South University from December 2020 to December 2023. Thirty-nine patients with secondary hypertension, included secondary hypertension caused by renal parenchymal hypertension, renal vascular hypertension, cortisol hypersecretion, pheochromocytoma and paraganglioma, thyroid and parathyroid diseases and aortic diseases, were excluded. A total of 243 patients were finally included, including 130 males and 113 females, with the age of [M(Q1,Q3)]50.0(41.0, 56.5) years. The patients were divided into PA group (n=135) and primary hypertension group (n=108) based on the cause of hypertension. Plasma aldosterone concentration (PAC) and renin activity (PRA) were measured at 2 hour of standing position. Twenty-four-hour urine samples were collected for determination of aldosterone by liquid chromatography tandem mass spectrometry. The area under receiver operating characteristic (ROC) curve was drawn to evaluate the value of 24-hour UEA and 24-hour UEA to renin ratio (UARR) in the screening of PA. Ninety-seven patients with PA subtypes identified based on adrenal vein sampling (AVS) and/or surgical pathology and postoperative follow-up results were enrolled. They were divided into unilateral primary hyperaldosteronism (UPA) group (n=54) and idiopathic hyper aldosteronism(IHA) group (n=43). ROC was drawn to evaluate the value of serum potassium, standing PAC, aldosterone to renin ratio (ARR), 24-hour UEA and UARR in the diagnosis of PA typing. Results: Serum potassium and PRA in PA group were lower than those in primary hypertension group (all P<0.01), while systolic blood pressure, diastolic blood pressure, blood sodium, urine potassium, PAC, ARR, UEA and UARR in PA group were higher than those in primary hypertension group (all P<0.05). The area under ROC curve for 24-hour UEA diagnosis of PA was 0.848(95%CI:0.799-0.897), the cut-off value was 8.42 μg/d, sensitivity and specificity were 99.3% and 59.3%, respectively. The area under the ROC curve was 0.986(95%CI:0.977-0.996), with sensitivity and specificity of 100.0% and 88.0%, respectively. The area under the ROC curve of UARR was 0.988(95%CI: 0.980-0.997), the cut-off value was 20.3 (μg/d)/(ng·ml-1·h-1), sensitivity and specificity were 90.4% and 83.2%, respectively. There was no significant difference between UARR and ARR (P>0.05). Subgroup analysis shows that the areas under the ROC curves for the diagnosis of 24-hour UEA and UARR in differentiating UPA from IHA are 0.772(95%CI:0.679-0.865) and 0.664(95%CI:0.539-0.764), respectively. The sensitivity of 24-hour UEA>16.8 μg/d and UARR>135.0 (μg/d)/(ng·ml-1·h-1) to predict UPA was 59.3% and 61.1%, respectively, and the specificity was 86.0% and 74.4%, respectively. Conclusions: Twenty-four-hour UEA can provide reference for clinical screening and diagnosis of PA. If combined with renin activity detection, it can provide screening value comparable to ARR. In addition, 24-hour UEA and UARR can be used as better predictors of PA typing diagnosis.

Pregnancy-related acute kidney injury leads to hypertension, reduced kidney function and cognitive impairment in postpartum rats.

Women with hypertensive disorders of pregnancy such as HELLP (hemolysis, elevated liver enzyme, low platelet) Syndrome are affected by acute kidney injury during pregnancy (PR-AKI) at higher rates than women without hypertension. Both hypertensive disorders of pregnancy and Acute Kidney Injury (AKI) outside the context of pregnancy have been associated with an increased risk of developing Chronic Kidney Disease (CKD) and cognitive impairment. In our current study, we set out to determine if PR-AKI led to the development of CKD and impaired cognition in the postpartum period and if HELLP syndrome exacerbates the impairments. Using timed-pregnant Sprague Dawley rats, on gestational day (GD) 12, mini-osmotic pumps infusing anti-angiogenic factors were surgically placed in the intraperitoneal cavity to induce HELLP. On GD18, AKI was induced via bilateral renal reperfusion ischemia surgery. Mean arterial pressure and birth outcomes were used to assess the global effects of AKI, and liver enzymes were used to assess HELLP. CKD was assessed by measuring glomerular filtration rate (GFR), urinary output, and renal fibrosis. Anxiety-like behaviors, object recognition memory, spatial memory, and avoidance memory were assessed via behavioral experiments. HELLP + AKI rats demonstrated more evidence of renal injury, hypertension, and behavioral deficits compared to normal pregnant animals. In addition, AKI had a negative impact on birth outcomes and maternal survival. HELLP + AKI together led to evidence of persistent hypertension, progressive renal dysfunction, and cognitive impairment, which were exacerbated compared to AKI or HELLP alone. These findings suggest that PR-AKI in the presence of a hypertensive disorder of pregnancy, such as HELLP, leads to the development of CKD, cognitive dysfunction, and hypertension.

OCTA evaluates changes in retinal microvasculature in renal hypertension patients

The objective of this study is to utilize optical coherence tomography angiography (OCTA) techniques for the purpose of identifying abnormalities in retinal and conjunctival vascular density among patients afflicted with renal hypertension. From October 2022 to October 2023, a cohort of sixteen patients diagnosed with renal hypertension (RH), comprising a total of 32 eyes, was selected from the Department of Nephrology at the First Affiliated Hospital of Nanchang University. Concurrently, a group of sixteen healthy individuals, carefully matched in characteristics, was recruited from volunteers at the Ophthalmology Research Center and designated as the healthy controls (HCs) group. Optical coherence tomography angiography was employed to assess and examine the superficial vascular plexus (SVP) and deep vascular plexus (DVP) of the macular retina in both eyes. Subsequently, a comparative analysis was conducted between the two groups, focusing on the superficial and deep retinal microvessels (MIR), macrovascular (MAR), and total microvascular (TMI). The present study employed the central annuli segmentation method (C1–C6), the hemispheric segmentation method (SL, IL, SR, IR), and the Early Treatment Diabetic Retinopathy Study (S, I, L, R) to evaluate deviations in retinal blood vessel density. The investigation aimed to examine the association between blood vessel density and TMI in conjunctival capillaries. A statistically significant difference (p < 0.05) in macular retinal vascular density was observed between the two groups based on the OCTA data. Specifically, in SVP, the density of TMI, MIR, and MAR in the RH group was significantly lower compared to the HCs group (p < 0.05). Additionally, the deep density of TMI and MIR in DVP of the RH group was significantly lower than that of the HCs group (p < 0.05). Furthermore, using the hemispheric segmentation method, both the superficial and deep retina showed a significant reduction in the density of SL, SR and IL regions (p < 0.05). In the ETDRS method, there was a significant decrease in superficial and deep retinal S, I, and L in the RH group (p < 0.05). When applying the central annuli segmentation methods, the RH group exhibited a significant decrease in the superficial retinal C1–3 region (p < 0.05) and a noticeable reduction in the deep retina in the C1–4 region (p < 0.05). Furthermore, a higher positive likelihood ratio was observed in the deep SL and superficial C2 region. There was a positive correlation between conjunctival capillary density and the region of TMI in depth. The results of the OCTA investigation revealed a significant disparity in the density of superficial and deep retinal blood vessels between RH group and the HCs group. Additionally, a notable correlation was observed between the depth of TMI and the density of conjunctival capillaries. These findings highlight the potential of retinal OCTA as a valuable tool for early detection and image-assisted diagnosis of retinopathy progression in patients with RH.

Renovascular hypertension - a primer for the radiologist.

Renovascular hypertension (RVHT) is an important cause of secondary hypertension, accounting for approximately 75% of cases. This pictorial review describes the imaging modalities used to diagnose RVHT, including ultrasound, computed tomography angiography, and magnetic resonance angiography, provides their benefits and limitations, and explores the imaging findings, diagnostic criteria, and management of multiple causes of RVHT. Atherosclerosis is the most common cause of RVHT, particularly in older individuals, while fibromuscular dysplasia is more prevalent in younger females. Less common discussed etiologies include polyarteritis nodosa, extrinsic compression, Page kidney, dissection, renal artery (RA) thrombus, and RA aneurysms. This paper also highlights the importance of recognizing anatomical variants and rare conditions that can impact diagnosis and management. While RVHT represents a minority of hypertension cases, its potential reversibility makes accurate diagnosis crucial. Treatment approaches vary based on etiology and may include medical management, angioplasty, stenting, or surgical intervention. This review aims to enhance radiologists' understanding of RVHT, facilitating improved diagnosis and patient care.

Multiple Treatment Strategies of Accessory Renal Artery Related Hypertension: Report of Two Cases and Literature Review.

Renovascular hypertension (RVH) is a primary cause of secondary hypertension, primarily driven by the activation of the renin-angiotensin-aldosterone system activation. Recently, growing studies suggested accessory renal artery (ARA) might also contribute to RVH. However, the treatment of ARA-related hypertension and whether to take interventional treatment lack consensus. Herein, we report two cases of ARA-related hypertension in our hospital. Imaging studies of both patients showed ARA stenosis. One patient had ARA occlusion well-compensated through tortuous collateral branches, achieving normal blood pressure by medical treatment alone. The other patient had ARA stenosis coexisted with main renal artery stenosis, and revascularization of both arteries led to a significant postoperative reduction in blood pressure. A literature review was conducted to summarize overall treatment strategies for ARA-related hypertension and clarify the relationship between ARA and hypertension. Recent research supported an association between ARA and hypertension. While medical therapy remains the first-line treatment for ARA-related hypertension, interventional procedures should be considered for patients whose blood pressure remains uncontrolled despite conservative management.

Renovascular hypertension following by juxtaglomerular cell tumor: a challenging case with 12-year history of resistant hypertension and hypokalemia

BackgroundAdolescents with secondary hyperaldosteronism often present with severe and treatment-resistant hypertension, along with hypokalemia. Renovascular hypertension is frequently caused by renal artery stenosis, primarily due to atherosclerosis and fibromuscular dysplasia (FMD). The presence of an accessory renal artery (ARA) is a common anatomical variation that can contribute to secondary renal vascular hypertension. However, FMD occurring in the ARA is a rare cause of renal vascular hypertension. Juxtaglomerular cell tumor (JGCT) represents a rare etiology of renal hypertension. The co-occurrence of the pathogenic ARA with JGCT is infrequently reported in the existing literature.Case presentationsThis case study presents a young individual with a 12-year history of resistant hypertension, initially diagnosed with pathogenic ARA but later confirmed as JGCT 4 years later. Following surgery for JGCT, the patient experienced only temporary stabilization of blood pressure without anti-hypertensive medication. Stenosis of the ARA was definitively diagnosed one and a half years post-surgery, with FMD occurring on the ARA strongly suspected. The patient underwent balloon dilatation angioplasty 3 years later, leading to sustained blood pressure stability with the use of two medications.ConclusionsThe case study discussed herein involves a patient with resistant hypertension initially diagnosed with ARA but later determined to have late-onset JGCT and renal artery stenosis. It is imperative to consider atypical JGCT in young patients exhibiting resistant hypertension, hypokalemia, and hyperreninemia. Adequate management of renal artery stenosis is crucial in the management of hyperreninemic hypertension.

Design and implementation of digital home blood pressure monitoring based on Bluetooth and WeChat App in the FAIR-Pilot study

Abstract Background Home blood pressure monitoring (HBPM) could be an alternative way to office blood pressure and ambulatory blood pressure monitoring for hypertensive patient management. However, the measurement protocol of HBPM still requires standardization, which may be improved by digital technology. Purpose To investigate the use of digital HBPM management in hypertensive patients and its application in clinical practice. Methods Fractional Flow Reserve to Determine the Appropriateness of Percutaneous Renal Artery Intervention in Atherosclerosis Renal Hypertension Patients (FAIR)-pilot study is a multicenter pilot randomized controlled trial exploring the application of fractional flow reserve (FFR) to guide the renal artery stenting in patients with renovascular hypertension. After randomization and FFR measurement, participants were divided into stenting with FFR≥ 0.8 (Stent group), no stent implantation with FFR≥ 0.8 (No stent group), and stenting with FFR＜ 0.8 (Controlled group). Participants of the FAIR-pilot study enrolled from February 1st, 2023 to February 25th, 2024 were included. A validated Bluetooth blood pressure monitor was given to every participant at the time of enrollment. Participants were taught to undertake standardized HBP and were advised to take morning and night HBPs every day. HBPM data were automatically uploaded to a WeChat App developed by FAIR investigators and could be reviewed by both participants and investigators. Twice-daily blood pressure reports were automatically generated and sent to investigators for participant compliance monitoring and reminding (Figure 1). HBPM data and blood pressure variability were analyzed. Results A total of 93 participants with 58 males (62.4%) and a mean age of 59.97 ± 16.18 years, including 26,802 HBP readings were analyzed. The average numbers of daily HBP measurement were similar between three groups and were all less than twice a day. Systolic HBP decreased from 143.11 ± 14.91 to 133.01 ± 13.01mmHg after the procedure in the Controlled group, which was more than the other two groups (140.51 ± 13.38 to 138.53 ± 17.30 mmHg and 136.20 ± 15.67 to 130.84 ± 11.04 mmHg). During the follow-up after the procedure, the HBP variability (BPV) of overall participants was 13.78 ± 4.87 and 5.46 ± 3.14 for systolic and diastolic BP, respectively. The systolic BPV of No stent group was higher than the other two groups (No stent vs. Stent vs. Controlled: 33.00 ± 9.49 vs. 8.34 ± 2.86 vs. 9.12 ± 2.71, P=0.125), however without statistical significance. Similar was found for morning and night systolic BPVs. (Table 1). Conclusion Digital HBPM management via novel information technology is feasible in the hypertension field and could be a helpful tool in clinical practice.

Combining fractional flow reserve and the index of microcirculatory resistance for prognosis prediction in renal artery stenosis interventions: a feasibility sub-study of FAIR-pilot trial

Abstract Background Interventional therapies for renal artery stenosis (RAS) was debatable in previous randomized trials. Fractional flow reserve (FFR), while useful in coronary interventions, does not assess microcirculatory status, which may be critical in RAS. The index of microcirculatory resistance (IMR) provides additional microvascular information, which has not been used in RAS patients. Purpose To investigate the feasibility of IMR measurement in RAS patients and the association with the outcome. Methods FAIR-pilot study is a multicenter pilot randomized controlled trial exploring the application of FFR to guide the renal artery stenting in patients with renovascular hypertension (NCT05732077). A pressure-temperature sensor guidewire was used to measure the IMR. To derive mean transit time at rest, thermodilution curves were obtained by 3 injections of 4 mL of room temperature saline down the renal artery. Hyperemia was induced using dopamine 50μg/kg bolus to the renal artery. The IMR was calculated as distal arterial pressure (Pd) x mean transit time during hyperemia (TmnH) (Figure 1). Prognostic evaluation was based on improvements in postoperative blood pressure, which was assessed using both ambulatory blood pressure monitor (ABPM) and anti-hypertensive medication number, along with renal function, as determined by the estimated glomerular filtration rate (eGFR). Results The IMR was measured among five patients enrolled in FAIR-pilot study. As shown in Table 1 and 2, stent implantation was conducted on five lesions across patients 1 to 4 based on renal FFR &amp;lt; 0.8, with each experiencing varying degrees of improved blood pressure control subsequently. Patient 5 did not receive a stent and was lost to follow-up. At three-month, the recorded decrease in systolic blood pressure ranged from a maximum of 34 mmHg to a minimum decrease of -6 mmHg among the four patients. The antihypertensive medication number showed a maximum reduction of 2 and no change as the minimum. We observed a correlation between baseline IMR and baseline renal function. No significant change in IMR was noted after interventional procedures. Preliminary findings suggest that IMR measurement is feasible in patients with RAS, while the ∆T (temperature change time) was very small, which potentially increasing the measurement bias. Conclusion The study suggests measuring IMR in patients with RAS is feasible and can offer information into the renal microvasculature. However, the small ∆T encountered during measurement may introduce increased bias, which should be considered when interpreting results.