Spence J D
Stroke Prevention and Atherosclerosis Research Centre, Siebens-Drake/Robarts Research Institute, London, Ont., Canada.
Cerebrovasc Dis. 2000 Jul-Aug;10(4):249-54. doi: 10.1159/000016066.
Patients with carotid stenosis are at high risk of vascular events and therefore require an optimal control of risk factors such as hypertension. As the treatment of hypertension differs according to the cause, we examined the prevalence of resistant hypertension, and the cause of hypertension, among patients with carotid stenosis followed closely in two randomized trials of carotid endarterectomy.
The purpose of this study was to determine the prevalence of resistant hypertension and of secondary hypertension among patients with carotid stenosis.
A chart review was performed of all patients from our center who participated in the North American Symptomatic Carotid Endarterectomy Trial or the Asymptomatic Carotid Artery Study to determine the prevalence of renovascular hypertension.
Among 170 patients with carotid stenosis followed in these two trials, 145 (83.5%) were hypertensive (systolic >160 or diastolic >90 mm Hg); at least 24 (14.1% overall, 16.6% of hypertensives) had renovascular hypertension based on either nuclear medicine renography, renal angiography or both; among the 79 patients with resistant hypertension (mean arterial pressure >130 mm Hg despite treatment), 20 (25.3%) had renovascular hypertension. Adrenocortical hyperplasia was the underlying cause of hypertension in 12 (7.1% of cases, 8.3% of hypertensives, 8.8% of resistant hypertensives). Blood pressures were significantly higher for patients with renovascular and adrenocortical hypertension (p < 0.0001 for systolic, p = 0.024 for diastolic pressures).
Among patients with carotid stenosis, renovascular hypertension is unusually common. Resistant hypertension among such patients should lead to investigation and management directed at the cause of hypertension. Appropriate investigations might include plasma renin/aldosterone ratio, captopril renography and MRA of the renal arteries or renal angiography.
颈动脉狭窄患者发生血管事件的风险很高，因此需要对高血压等危险因素进行优化控制。由于高血压的治疗因病因不同而异，我们在两项颈动脉内膜切除术随机试验中，对密切随访的颈动脉狭窄患者中难治性高血压的患病率以及高血压的病因进行了研究。
本研究的目的是确定颈动脉狭窄患者中难治性高血压和继发性高血压的患病率。
对我们中心参加北美症状性颈动脉内膜切除术试验或无症状颈动脉动脉研究的所有患者进行病历审查，以确定肾血管性高血压的患病率。
在这两项试验中随访的170例颈动脉狭窄患者中，145例（83.5%）患有高血压（收缩压>160或舒张压>90 mmHg）；根据核医学肾图、肾血管造影或两者，至少24例（总体为14.1%，高血压患者中为16.6%）患有肾血管性高血压；在79例难治性高血压患者（尽管接受治疗，平均动脉压>130 mmHg）中，20例（25.3%）患有肾血管性高血压。肾上腺皮质增生是12例高血压的潜在病因（占病例的7.1%，高血压患者的8.3%，难治性高血压患者的8.8%）。肾血管性高血压和肾上腺皮质性高血压患者的血压明显更高（收缩压p<0.0001，舒张压p=0.024）。
在颈动脉狭窄患者中，肾血管性高血压异常常见。此类患者的难治性高血压应促使针对高血压病因进行调查和处理。适当的检查可能包括血浆肾素/醛固酮比值、卡托普利肾图以及肾动脉磁共振血管造影或肾血管造影。
