Renovascular hypertension: what is it? Treatment, causes, symptoms, prevention

When the diameter of the renal artery is narrowed, renal blood flow significantly worsens. The pathological phenomenon is typical for such an ailment as renovascular hypertension. This is one of the types of hypertension that occurs in only 3-5% of patients suffering from high blood pressure. Symptoms of the disease depend on the reasons that led to its development. Let us consider in more detail the pathogenesis, clinical picture, methods of diagnosis and treatment of this disease.

Renovascular hypertension - what is it?

Currently, the pathologies of the cardiovascular system are increasingly being diagnosed not only in the elderly, but also among the younger generation. This is due to the negative impact of various factors: hereditary predisposition, harmful habits, the presence of chronic diseases. The disease can cause the development of other similar pathologies. One of these diseases is renovascular hypertension.

The syndrome occurs against a background of constriction of blood vessels in the kidneys and worsening of blood circulation. In the absence of timely treatment, the disease can lead to tissue ischemia, kidney failure. Diagnosis of the disorder is only in a small number of patients who have problems with blood pressure. Renovascular hypertension can affect one or both of the kidneys.

Pathogenesis

According to studies conducted by specialists, narrowing of the renal artery causes an increased synthesis of renin, a component that regulates blood pressure and is responsible for reducing the volume of peripheral vessels. This is necessary to normalize the blood supply to the kidney. However, the narrowed lumen of the artery does not allow the blood flow to be regulated.

Simultaneously with this process, there is an increased activity of aldosterone and angiotensin in the blood. The first substance is a hormone secreted by the adrenal glands. It is released due to angiotensin (an oligopeptide hormone) and affects only the healthy kidney, reducing urine production due to sodium retention. This does not allow the kidneys to fully perform their blood purification functions and causes the development of such an ailment as renovascular hypertension.

The pathogenesis of the disease gives an idea of how the syndrome is born, and what needs to be done to restore the proper functioning of the kidneys. With complete normalization of blood circulation in the affected vessels, the patient's condition improves and the ailment recedes.

Causes of the disease

Currently, doctors call several main reasons that can serve as an impetus in the development of the pathological condition. Vasorenal (Renovascular) hypertension most often occurs against the background of the following diseases:

• Atherosclerosis is the main cause of development of nephrogenic arterial hypertension. Cholesterol plaques narrow the lumen of the vessels by about half at the site of entry into the kidney. The disease most often affects men aged 40-55 years. In women, the pathology is usually manifested after 60 years.
• Fibromuscular dysplasia of the renal arteries is an inflammatory process in which the structure of the muscular tissue of the vessels changes. Hyperplasia is common in young people, as well as in childhood. In addition to hyperplasia of the muscle elements, there is a formation of microaneurysms. The etiology of fibromuscular dysplasia is unknown.
• Takayasu's disease is a syndrome associated with inflammation in the aorta and the formation of a thrombus. The disease is also called a disease of lack of pulse. Vascular narrowing leads to a thickening of the vascular membranes against the background of the destruction and swelling of the vascular tissue. The disease has an autoimmune etiology.
• Mechanical compression of the vessels - arises against the background of the formation of tumors, cysts and aneurysms of blood vessels. Renovascular hypertension develops when blood flow is disturbed. What it is and how to deal with this ailment will be discussed below.

Clinical picture

The symptomatology of the disease has signs of arterial hypertension and renal pathology. The severity of the clinical picture of the disease depends on the form of the course of reninvascular hypertension and the factors that led to its development. With the rapid development of characteristic symptoms speak of a malignant type. If the pathology develops slowly - the disease is benign.

In most cases, severe renovascular hypertension is diagnosed. Symptoms of the disease are as follows:

• Stably high blood pressure values, which do not decrease even with the use of medicines;
• Increased diastolic pressure against the background of normal systolic;
• Hypertrophy of the myocardium;
• Increased pressure on the background of severe pain in the lumbar region;
• Noise when listening to the renal arteries.

At a young age, sharp jumps in blood pressure should be alarming. Especially it concerns those cases when the nearest relatives did not suffer from arterial hypertension and the ailment could not be inherited.

Signs of benign and malignant renovascular hypertension

With a slow course of development of the pathological process, an insignificant increase in the "upper" pressure is observed and a significant increase in the indices of the "lower" pressure. For example, 130/110 or 140/110 mm Hg. Art. In this case, the patient complains of general deterioration of the condition, the appearance of dyspnea, weakness.

The appearance of such symptoms as a deterioration of vision, severe pain in the neck, nausea and vomiting, an increase in the "lower" pressure to 120 mm Hg. Art. Says that malignant renovascular hypertension develops. What forecast does the expert give in this case? It is extremely unfavorable, because patients rarely apply for qualified medical care in a timely manner.

To correctly diagnose and prevent the development of a severe course of the pathology, a checkup should be performed on the appearance of the first symptoms of hypertension.

Methods of diagnosis

At the initial reference the specialist will send the patient to a laboratory test. To make an accurate diagnosis of only one of the symptoms and complaints of the patient in this case is almost impossible. It is necessary to pass tests to determine the level of cholesterol, creatinine, renin, potassium and aldosterone in the blood. The analysis of blood serum on ACE allows you to determine the stenosis of the arteries. Laboratory studies help differentiate the ailment from inflammatory processes in the kidneys.

Instrumental methods of examination are mandatory in case of suspected development of such a serious disease as renovascular hypertension. Diagnosis usually begins with an ultrasound, during which you can determine the size of the kidneys, the presence of tumors and cysts, an abnormal development of the organ.

Angiography is used to study the state of the kidney vessels. The method allows to determine the degree of their narrowing due to the introduction of a contrast medium. The method of diagnosis has a number of contraindications, which should be read beforehand.

To assess the blood flow in the vessels of the kidneys allows dopplerography. This is one of the methods of ultrasound. However, unlike conventional ultrasound, Doppler helps to obtain more valuable information. He is appointed with an unidentified etiology of hypertension, to assess the size of the neoplasm and the blood flow in them, with suspected renal failure.

Radionuclide urography

Renovascular hypertension is often diagnosed with radionuclide urography. The method involves the introduction into the body of a small amount of a radioactive preparation. The activity of the medication is fixed by the gamma camera in front of which the patient is located.

The duration of the examination depends on the severity of the patient's condition. Usually the procedure is carried out for 1 hour. The images obtained as a result of the survey allow us to judge the work of both kidneys and the blood flow in them.

Radioactive drugs, in contrast to contrast agents, are much less likely to cause the development of any side effects.

Renovascular hypertension: treatment

Therapy of this type of hypertension presents significant difficulties. The ailment often manifests itself in its malignant form and shows resistance to medicines. With the rapid development of the symptoms of the disease, there may be abnormalities in the functioning of the liver, brain, and lungs. Usually, surgery is performed in these cases.

Radical methods of treatment allow (in most cases) to prevent serious consequences. Operative intervention is performed only if the kidneys retain their functions. One of the methods is balloon angioplasty. During the operation, a catheter with a silicone balloon at the end is inserted into the lumen of the stenotic artery. When the narrowed section is reached, the balloon is inflated, and the balloon, in turn, opens the microprosthesis located at the end of the catheter. The technique has several advantages - a small invasiveness and no narcosis for the operation.

It should be taken into account that the method described above is not suitable for diagnosing stenosis of vessels located at the mouth of the renal artery or when it is completely narrowed. In this case, an open surgical procedure is shown.

If the disease develops against a background of a tumor, cysts or hematomas, it is necessary to perform a surgical procedure and remove the tumor. This will restore the blood flow and functionality of the body.

In benign pathology, it is possible to reduce arterial pressure quite successfully, to eliminate pain syndrome in the kidney area with the help of conservative therapy. Arterial hypertension, including renovascular, is treated under the strict supervision of a specialist. Only a doctor can choose a complex therapy aimed at improving the patient's condition.

At an early stage of pathology development, the following groups of medicines are indicated:

1. Angiotensin receptor blockers (reduce the risk of heart attack and stroke);
2. ACE inhibitors have a (cytoprotective and vasodilating effect);
3. Calcium channel blockers (stabilize the level of calcium).

Renovascular hypertension is also treated with diuretics and drugs that lower blood pressure. The dosage of medications depends on the severity of the patient's condition. With prolonged use of medicines, it is necessary to check the level of potassium in the blood every six months. The most pronounced therapeutic effect is provided only by complex therapy in the maximum dosage of drugs.

Folk methods

The treatment of renovascular hypertension can also be performed with the help of folk methods. However, they are better used in conjunction with traditional medicine. Folk recipes allow you to normalize blood pressure, clear blood vessels from cholesterol plaques and improve blood flow. A good result is the use of dogrose. The plant has a powerful diuretic effect. With renal pressure, it is necessary to brew 1 tbsp. L. Fruit with a glass of boiling water, insist on a water bath for 15 minutes and take as tea twice a day.

To reduce high blood pressure will help infusion of leaves of cranberries. Preliminarily, the leaves (2 tbsp.) Are ground and poured into 250 ml of boiling water. The resulting mixture is insisted on a water bath for at least half an hour, filter, cool and take on the third part of the glass 3 times a day.

In the event that the renal vascular hypertension was diagnosed at the initial stage of development, it is possible to prepare an infusion of the following components:

• Peppermint - 2 tbsp. L .;
• Inflorescence of hawthorn - 3 tbsp. L .;
• Leaves of birch - 3 tbsp. L .;
• Leaves of kidney tea - 4 tbsp. L .;
• Motherwort - 4 tbsp. L.

The components of the drug collection must be thoroughly mixed in a separate container. Every day, you should prepare a fresh decoction of 3 grams of collection and 300 ml of boiling water. Infuse the broth for an hour. After percolation, the drink is taken 100 ml three times a day.

Great benefit for blood vessels will beet juice. It is recommended to use it daily for 100-120 ml, pre-adding honey or diluting the juice with clean water. The components contained in the juice, promotes the cleavage of cholesterol plaques and small blood clots.

Food

People who have been diagnosed with renova-vascular hypertension are shown a diet on an ongoing basis. It is necessary to limit consumption of soy, salt, fatty and smoked dishes. Beneficial to the body will bring sea kale, vegetables, fruits, animal proteins (eggs, milk). It is recommended to eat fatty fish daily.

Carbohydrates are the basis of dietary nutrition in kidney pathology. On a mandatory basis, the amount of protein consumed per day should be counted. In conditions of inpatient treatment, patients are assigned a dietary table number 7. For allergies to eggs, they can be replaced by dairy products.