Renovascular hypertension

Renovascular hypertension is caused by stenosis or obstruction of the main renal artery or its branches on one or both sides, leading to reduced renal blood flow or ischemia, and activation of the renin-angiotensin-aldosterone system, resulting in elevated blood pressure. Renal artery stenosis is the most important cause of renovascular hypertension. Typical symptoms of renovascular hypertension include headache, dizziness, nausea, hematuria, convulsions, proteinuria, atherosclerosis, abdominal vascular bruits, lower limb pain or radiating pain in the lower back, and fundoscopic changes. Currently, commonly used clinical examination methods include the sodium loading test, serum high-sensitivity CRP measurement, urinary IgG and urinary microtransferrin, plasma renin activity, renal ultrasound, renal CT, and split renal vein renin activity measurement. Current main treatment modalities include percutaneous transluminal renal angioplasty (PTRA), surgical treatment, and drug therapy. PTRA requires controlling the underlying disease before performing percutaneous transluminal renal angioplasty and renal artery stent placement. Surgical treatments include aortorenal bypass, renal artery endarterectomy, and autologous kidney transplantation. Medical drug therapy includes (1) treating the underlying disease, such as using immunosuppressants for Takayasu arteritis and lipid-lowering drugs and antiplatelet agents to prevent the progression of atherosclerosis; (2) antihypertensive therapy, as blood pressure is often difficult to control, multiple antihypertensive drugs should be combined to reduce side effects and increase efficacy. For those presenting with malignant hypertension, diuretics should be used with caution. If angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are used, they must be started at a low dose and gradually increased to avoid rapid deterioration of renal function. For patients with bilateral renal artery stenosis, ACEI and ARB should be prohibited. (3) Other symptomatic treatments, such as treatment for chronic renal failure. At the same time, daily health care must be carried out to more effectively control the rise in blood pressure. For patients with renovascular hypertension, it is generally recommended to measure blood pressure every morning and evening, 2-3 times each time, and take the average value; for those with stable blood pressure control, blood pressure can be measured only one day per week. For patients with newly diagnosed hypertension or unstable blood pressure, it is recommended to measure blood pressure at home continuously for 7 days (at least 3 days), once in the morning and once in the evening each day, 2-3 times each measurement, and use the average value of the last 6 days as the reference value.