Bavishi Chirag, de Leeuw Peter W, Messerli Franz H
Mount Sinai St. Luke's & Roosevelt Hospitals, New York, NY.
Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands; Orbis Medical Center, Sittard, The Netherlands.
Am J Med. 2016 Jun;129(6):635.e5-635.e14. doi: 10.1016/j.amjmed.2015.10.010. Epub 2015 Oct 29.
For many years and even decades, a diagnostic work-up to look for a secondary form of hypertension, particularly of renovascular origin, has been a central tenet in medicine. Atherosclerotic renal artery stenosis is considered the most common cause of renovascular hypertension. However, advances in understanding the complex pathophysiology of this condition and the recently documented futility of renal revascularization bring into question whether atherosclerotic renal artery stenosis truly causes "renovascular hypertension." From a clinical point of view, a clear distinction should be made between hypertension associated with atherosclerotic renal artery stenosis and hypertension caused by renal artery stenosis-induced activation of the renin-angiotensin-aldosterone system. Most patients with atherosclerotic renal artery stenosis do not have a form of hypertension that is remediable or improved by angioplasty; to expose them to the cost, inconvenience, and risk of a diagnostic work-up add up to little more than a wild goose chase. However, with very few exceptions, medical therapy with antihypertensives and statins remains the cornerstone for the management of patients with atherosclerotic renal artery stenosis and hypertension.
多年甚至几十年来，寻找继发性高血压（特别是肾血管性起源）的诊断检查一直是医学的核心原则。动脉粥样硬化性肾动脉狭窄被认为是肾血管性高血压最常见的原因。然而，对这种疾病复杂病理生理学的认识进展以及最近记录的肾血管重建术的无效性，让人质疑动脉粥样硬化性肾动脉狭窄是否真的会导致“肾血管性高血压”。从临床角度来看，应明确区分与动脉粥样硬化性肾动脉狭窄相关的高血压和由肾动脉狭窄诱导的肾素-血管紧张素-醛固酮系统激活所引起的高血压。大多数动脉粥样硬化性肾动脉狭窄患者并不具有可通过血管成形术治愈或改善的高血压形式；让他们承受诊断检查的费用、不便和风险，结果不过是徒劳无功。然而，除了极少数例外情况，使用抗高血压药物和他汀类药物进行药物治疗仍然是动脉粥样硬化性肾动脉狭窄和高血压患者管理的基石。
