Morphological and functional renovascular changes as cause of resistant arterial hypertension - case report and literature review

Vol. 59 No. 1, 2018

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Irina Iuliana Costache, Claudia Florida Costea, Vasile Fotea, Victor Laurian Rusu, Viviana Aursulesei, Razan Al Namat, Dan Alexandru Costache, Nicoleta Dumitrescu, Catalin Mihai Buzduga, Gabriela Florenta Dumitrescu, Anca Sava, Camelia Margareta Bogdanici

Resistant hypertension is defined by the inability to maintain within normal limits the blood pressure values of an individual, while he is under treatment with maximal tolerated doses of three antihypertensive agents. One of the most common types of resistant hypertension is renovascular hypertension (RVH), which is caused by the narrowing of the renal arteries, in the context of existing atherosclerotic plaques at that level. We are presenting the case of a hypertensive 56-year-old man admitted in the Clinic of Cardiology for a sudden rise of his blood pressure values, despite undergoing the scheduled treatment. The abdominal bruit discovered at the clinical examination and the hypokalemia, together with the mild impairment of the renal function raised the suspicion of an existing stenosis of the main renal blood vessels. Simple grey scale kidney ultrasound, Doppler ultrasound of the renal arteries, abdominal computed tomography and magnetic resonance angiography of the renal arteries, along with invasive renal angiography demonstrated a smaller right kidney, adrenal incidentalomas, reduced vascular diameter of renal arteries due to atheromatous lesions, thrombosis of the infrarenal segment of the abdominal aorta, and reduced vascular hemodynamics in the same territories. After the renal arteries revascularization and with minimal antihypertensive treatment, the patient had a favorable outcome, with normalization of blood pressure and renal function. Atherosclerotic disease causing renal artery stenosis is essential to be taken into consideration in the etiopathogenesis of resistant hypertension especially because RVH is a potentially curable disease.

Corresponding author: Claudia Florida Costea, Assistant Professor, MD, PhD; e-mail: costea10@yahoo.com; Victor Laurian Rusu, MD; e-mail: rusu.victorl@gmail.com

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