Isolated systolic hypertension in uremic hemodialyzed patients]

Prevalence of Isolated Systolic Hypertension (ISH) defined as systolic blood pressure greater than 160 mmHg and diastolic blood pressure less than 90 mmHg was studied in a population of 148 patients treated by hemodialysis whose 80 had undergone ambulatory blood pressure (ABP) recording during the interdialytic period. All patients were treated 3 times 4 hours a week. ABP was recorded for 48 hours between two sessions of hemodialysis using a Delmar Avionic Presurometer (PIV). Prevalence of ISH was 12.5%, while that of systolic-diastolic hypertension (SDH) was 15%. Average age at the time of the study was respectively 59 +/- 13 yrs ISH and 49 +/- 11 yrs SDH (p less than 0.01) while that of patients with normal blood pressure (N) was 57 +/- 10 yrs. Mean duration of HD treatment was no different between groups: 5.3 +/- 3.5 yrs ISH, 5.0 +/- 4.2 yrs SDH and 5.0 +/- 4.3 yrs N. Causes of end-stage renal disease were similar in each group. All patients with ISH and SDH and 42% of N pts were receiving antihypertensive treatment at the time of ABP recording. Finally, level of anemia and percentage of patients treated by EPO were similar in each group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Essential hypertension and multiple renal arteries

Two hundred forty-three consecutive renal arteriograms were studied. Thirty-seven of 110 cases of essential hypertension (31 per cent) and 9 of 41 normotensive cases (22 per cent) revealed multiple renal arteries, showing that there is no significant difference in the incidence of multiple renal arteries between the two groups.     

Efficacy of spiral computed tomography in evaluation of renal arteries in patients with renovascular hypertension

The aim of this study is an estimation of efficacy of spiral computed tomography (SCT) in evaluation renal arteries in patients with renovascular hypertension. SCT was performed in 54 patients (32 females and 22 males) by means of Picker PQ 2000. The thickness 4 mm, index 4 mm, pitch 1.0. Contrast agents-Uropolinum 75% or Ultravist 350 were applied automatically 3-4 mm/sec. with delay 20-22 sec. Secondary reconstruction with 2 mm leyers was performed by Maximum Intensity Projection (MIP). In all patients the abdominal arteriography was performed as a reference method. The coincidence of both methods in evaluation of renal arteries occlusion or stenosis was estimated by Cohen kappa coefficient. In addition, sensitivity and specificity of SCT were estimated. RESULTS: Consistence of SCT and arteriography for right, left and additional renal artery were as follows: 0.914, 0.92, 0.85. Sensitivity and specificity SCT for rigt, left and additional renal artery were as follows: 95.5% and 95.8%, 96.5% and 95.8%, 50% and 100%. The highest efficacy of SCT was noted in ostium, the most difficult place in evaluation of renal artery during arteriography examination.     

Kidney function after reconstructive operations on the renal arteries in renovascular hypertension]

A total of 117 patients with renovascular hypertension operated upon by employing reconstructive surgery upon renal arteries for producing hypotensive effect and restoration of renal functions were examined. Examination was made before surgery, in the near (up to 6 months) and remote post-operative periods (after a lapse of up to 10 years time). Soon after the operation persistent normalization of the arterial pressure was recorded in 78 (67 per cent) of 117 patients, improvement supervened in 12 per cent of the cases, and a positive hypotensive effect could be achieved in 92 or 79 per cent of the patients. The immediate normalization and improvement in the evolution of arterial hypertension continue, as a rule, also late after surgery. Following reconstructive operations on the renal arteries with normalized arterial pressure or its improvement the great majority of the patients demonstrated re-establishment or a significant improvement of both the summary (filtration, concentration and even nitrogen-excretory) and individual renal functions (as shown by the results of radioisotope renography with I131 hippuranium and excretory urography. In patients with malignant course of arterial hypertension successful reconstructive surgery was followed by a tendency toward retrograde development of the arterial hypertension malignancy.     

Clinical results of angioplasty of the renal arteries in renovascular arterial hypertension. A retrospective study in 113 patients]

The aim of the study was to evaluate the clinical results of percutaneous transluminal renal angioplasty in a population of 113 consecutive hypertensive patients who underwent endoluminal revascularization for angiographically significant renal artery stenosis. Retrospective analysis of the case records of 104 patients showed that systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased significantly 6 months after angioplasty (-20.9 mmHg and -8.4 mmHg respectively; p = 0.0001). This decrease was maintained until 19.8 months after the procedure. In cases with suboptimal revascularization (persistence of a residual stenosis more than 30%), only the SBP decreased significantly at 6 months (from 177 mmHg to 156.1 mmHg; p = 0.0061); when DBP decreased from 91.4 mmHg to 86.1 mmHg (NS) at 6 months, and fell to 80.9 mmHg (p = 0.026) at 19.8 months (after the performance of a second transluminal angioplasty for 41% patients of this group due to restenosis). Twenty-nine patients presented a restenosis of the renal artery 6 months after the initial procedure. In this group, only SBP decreased significantly at 6.1 months and at 18.7 months (from 171.9 mmHg to 156.1 mmHg and 146.5 mmHg respectively; p = 0.0064 and p = 0.0001). DBP decreased significantly only at 18.7 months (-12.6 mmHg; p = 0.0001), after a second renal angioplasty in 23 patients (79%). In the 60 patients without restenosis at 6 months, SBP and DBP decreased significantly at 6.1 and 18.7 months. No significant variation of creatinine levels was observed. These results confirm the utility of percutaneous transluminal renal angioplasty for the treatment of renovascular hypertension.     

缬沙坦联合氟伐他汀治疗肾性高血压的临床观察

目的:观察缬沙坦与氟伐他汀联合应用对慢性肾病继发性高血压的治疗作用。方法:58例肾性高血压患者被随机分成两组,每组29例:在慢性肾病常规治疗基础上,缬沙坦对照组给予缬沙坦80mg1次/d口服,联合用药组在缬沙坦对照组的基础上加用氟伐他汀40mg1次/d口服,疗程8周。观察治疗前后血压、血肌酐(Scr)、尿素氮(BUN)、24h尿蛋白定量以及血脂的变化。结果:治疗后两组血压、Scr、BUN、24h尿蛋白均显著下降(P0.01),肾功能明显改善,联合用药组Scr[(286.37±84.72):(327.52±92.63)μmol/L]、BUN[(8.35±5.24):(9.46±6.14)mmol/L]、24h尿蛋白[(0.89±0.71):(1.52±0.84)g/L]、血脂均较缬沙坦对照组显著下降(P均0.05)结论:缬沙坦与氟伐他汀联合应用能有效减轻肾病高血压患者的肾脏损害,其疗效优于单用缬沙坦治疗。     

氨氯地平和苯那普利联合治疗对高血压患者肾功能的影响

目的探讨氨氯地平、苯那普利单独治疗和联合治疗对高血压病患者肾功能的影响。方法66例高血压病患者随机分为3组:氨氯地平组(5mg,qd,22例);苯那普利组(10mg,qd,22例);氨氯地平和苯那普利联合治疗组(氨氯地平5mg,qd,苯那普利10mg,qd,22例)。疗程24周。治疗前、后观察肾功能指标变化。结果①氨氯地平、苯那普利及联合治疗组高血压病患者治疗后均能显著降低血压(P<0.01)及尿蛋白的排泄量。但联合治疗组降低尿蛋白排泄的幅度比氨氯地平组、苯那普利组明显高,而氨氯地平组和苯那普利组之间差异无统计学意义(P>0.05)。②治疗后,肾小球滤过率在联合治疗及苯那普利组明显增高,而氨氯地平组无明显变化。③三组治疗后尿白蛋白下降幅度与血压下降幅度均无显著相关。结论氨氯地平、苯那普利长期单独治疗均可减少蛋白尿,保护肾功能,两药联合治疗对减少蛋白尿、保护肾功能有一定相加作用。     

Baroreflex control and circadian variability of arterial blood pressure in patients with "mild" hypertension and hemodynamically insignificant atherosclerotic lesions of the carotid arteries]

Sinocarotid baroreflex control by means of the neck chamber technique (-40 mm Hg, 4 min) and blood pressure monitoring with a SpaceLabs 90207 system were performed in 45 patients with mild essential hypertension who were divided into 2 groups: (1) those with hemodynamically insignificant carotid atherosclerotic lesions (n = 19) and (2) those without them (n = 26). Group 1 patients showed a decreased cardiochronotropic component of baroreflex control, higher blood pressure variability and less pronounced nocturnal blood pressure fall. The above facts are likely to contribute to progression of essential hypertension and aggravation of target organ lesions.     

氨氯地平和培哚普利联合治疗对高血压病患者肾功能的影响

探讨氨氯地平，培哚普利单独治疗和联合治疗对高血压病患者肾功能的影响。方法 ６６例高血压病患者随机分为三组：氨氯地平组；培哚普利组；氨氯地平和培哚普利联合治疗组。疗程２４周，治疗前后观察肾功能指标变化。结果 １．氨氯地平，培哚普利及联合治疗组高血压病患者治疗后均能显著降低血压及尿蛋白排泄量「２４小时尿白蛋白：１０２±３６．４．１０４．７±４２．７和１０１．４±０．０６５，０．２４±０．６２及０．２３     

Successful stenting of bilateral multiple renal arteries in a patient with renovascular hypertension

We describe the use of stenting in multiple renal arteries with severe ostial stenoses. A 62-year-old male with long-standing arterial hypertension despite treatment with multiple antihypertensive medications and mild renal impairment, appeared to have 5 renal arteries, 4 of which had severe ostial stenoses. Successful stent implantation of these 4 lesions was performed in one session. At 3-month follow up, the patient did well with adequate blood pressure control. In conclusion, stenting of ostial stenoses in multiple renal arteries appears to be a feasible and useful option in patients with renovascular hypertension.     

Regression of atherosclerotic stenosing lesions of the renal arteries and spontaneous cure of systemic hypertension through control of hyperlipidemia

We describe a 49 year old woman with impressive regression of renal artery stenosing atherosclerotic lesions in response to sustained excellent control of hyperlipidemia.Initially, she had high blood pressure necessitating combined drug therapy with chlorothiazide, methyldopa and propranolol, with only moderately satisfactory control. Renal arteriography revealed a 90 per cent stenosing lesion of the right renal artery and 75 per cent narrowing of the left renal artery. Peripheral vein plasma renin was markedly increased at 32 ng/ml. With a combination of cholestyramine and clofibrate, serum lipids were maintained at normal values for several years. Increased blood pressure diminished spontaneously, and the patient has maintained normal blood pressures after discontinuation of antihypertensive therapy. Repeat renal arteriograms showed almost complete regression of the right renal artery lesion and a possible decrease in left renal artery disease. Peripheral vein plasma renin became normal at 3 ng/ml.This case illustrates that sustained control of hyperlipidemia could lead to regression of atherosclerotic nodules and impressive clinical improvement in certain patients.     

Primary pulmonary hypertension and abnormalities of pulmonary arteries]

Case report of a 5 year old boy with a well diagnosed primary pulmonary hypertension, combined with anomalies of the pulmonary arteries of the left upper lobe of the lungs with angiographically loopy appearance. Congenital heart and vascular disease did not exist; AV-fistulae were not found. There is no proof of a connection between the anomalies of the pulmonary arteries and pulmonary hypertension. There was no similar case in the current literature to be found.     

Treatment of hypertension in patients with renal disease

Management of hypertension in people with kidney disease is challenging and generally requires at least three different and complementary acting antihypertensive agents to achieve the recommended blood pressure goal by the JNC VI and WHO guidelines of <130/85 mmHg. This is also true for the recent blood pressure goal for diabetes of <130/80 mmHg recommended by both the National Kidney Foundation and American Diabetes Association for reduction of cardiovascular risk and preservation of kidney function. Commonly used combinations include an ACE inhibitor, which has compelling indications for use in people with kidney disease with a diuretic, generally a thiazide type agent. Angiotensin receptor blockers have clearly shown effectiveness for slowing nephropathy progression in Type 2 diabetes and clearly have a role as first-line agents in that disease. If additional therapy is required, either a beta blocker or calcium antagonist may be added to this antihypertensive 'cocktail'. Beta blockers are particularly effective in people with a high sympathetic drive, i.e. high pulse rates, to lower pressure and reduce cardiovascular risk. Moreover, in recent studies their benefits on kidney function both by reducing proteinuria and slowing decline of kidney function make them good agents to add in the appropriate clinical setting. Given recent data from an analysis of the NHANES III database showing only 11% of people being treated for hypertension with diabetic kidney disease have achieved the blood pressure goal of <130/85 mmHg, it's no wonder the incidence of people starting dialysis continues to climb. Physicians need to work harder and educate patients on the importance of achieving these lower blood pressure guidelines.