Cooperative study of radiologic aspects of renovascular hypertension. Bilateral renovascular disease

Abnormal urographic features were present in 60.7% of 250 patients with bilateral diseases. The urogram was relatively insensitive in the minority of patients whose lesions were of approximately equivalent severity bilaterally. In bilateral renovascular disease, the urogram demonstrated some surgical prognostic value that was not evident in unilateral renovascular disease. Furthermore, in patients with bilateral disease, the urogram was helpful in deciding between unilateral or bilateral operation.     

Selective renal artery embolization. Treatment of acute renovascular hypertension

A critically ill patient with severe renovascular hypertension following surgical repair of an aortic dissection was treated by percutaneous selective embolization of the ischemic kidney. Correction of the hypertension and subsequent complete recovery of the patient resulted.     

Withdrawal of antihypertensive therapy. Hypertensive crisis in renovascular hypertension

Hypertensive crises were reported in three patients with hypertension associated with underlying renovascular occlusive disease during reduction of antihypertensive therapy. In each case, rebound hypertension was observed during clonidine hydrochloride withdrawal. Therapy with propranolol hydrochloride and diuretics had also been discontinued in two of the three patients. This and other reports of rebound hypertension during clonidine withdrawal are contrasted with the absence of reports of this syndrome in the setting of cessation of beta-adrenergic blockade therapy. This suggests that the discontinuation of clonidine therapy was primarily responsible for the hypertensive crises herein described. It is further concluded that rebound hypertension may follow gradual as well as abrupt reduction of clonidine dosage, and that patients with renovascular hypertension may be at greatest risk.     

Advances in diagnosis and treatment of renovascular hypertension

In approximately 5% of the hypertensive population, hypertension is of a renovascular origin. Some of these patients may be cured of their disease by the modern treatment of transluminal dilatation of the stenosed renal artery. They no longer require hazardous surgery or life-long antihypertensive medication with its associated problems of side-effects, expense, and patient compliance. Decisions need to be made about which hypertensive patients should be investigated, how extensively, and the tests which should be performed to identify patients with this remediable form of hypertension.     

Effects of atrial natriuretic factor on patients with renovascular hypertension.

Previous studies have shown the effects of atrial natriuretic factor (ANF) on rats with renovascular hypertension (RVH). In the present study low dose alpha-hANF (0.025 microgram/kg/min) was administered intravenously for 60 minutes to seven RVH patients. Results demonstrated an inhibition of renin-angiotensin-aldosterone system (RAAS), reduction of plasma catecholamine and arginine vasopressin(AVP), diuresis and natriuresis, increase of hematocrit and creatinine clearance, and slight decrease of blood pressure. These results showed that most factors involved in the establishment and maintenance of RVH are affected by ANF infusion.

     

阿托伐他汀对肾血管性高血压大鼠心肌纤维化及TGF-β1表达的影响

目的 探讨阿托伐他汀对肾性高血压大鼠心肌纤维化以及转化生长因子β1(TGF-β1)表达的影响. 方法 24只实验大鼠建立肾性高血压大鼠模型,随机分为三组(每组8只):对照组、高血压组、阿托伐他汀组.术后4周末阿托伐他汀组开始用阿托伐他汀[50 mg/(kg*d)]连续灌胃8周.测量大鼠尾动脉收缩压、检测心肌胶原浓度(用心肌羟脯氨酸含量表示)、心肌总胶原容积分数(t-CVF)以及免疫组化检测心肌TGF-β1的表达. 结果 高血压组尾动脉收缩压、心肌羟脯氨酸含量、t-CVF以及TGF-β1的表达显著高于对照组(P<0.01);阿托伐他汀组大鼠的心肌羟脯氨酸含量、t-CVF和TGF-β1的表达低于高血压组(P<0.05). 结论 阿托伐他汀具有抑制心肌纤维化的作用,其机制可能与下调TGF-β1的表达有关.