Boutari Chrysoula, Georgianou Eleni, Sachinidis Alexandros, Katsimardou Alexandra, Christou Konstantinos, Piperidou Alexia, Karagiannis Asterios
Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece.
Curr Hypertens Rev. 2020;16(1):24-29. doi: 10.2174/1573402115666190416153321.
Renovascular hypertension (RVH) remains among the most prevalent and important, but also potentially reversible, causes of secondary hypertension. The predominant causes of renal artery stenosis (RAS) are atherosclerotic renovascular arterial stenosis (ARAS) and renal fibromuscular dysplasia. This condition can lead to progressive renal injury, cardiovascular complications and 'flash pulmonary edema'. Duplex Doppler ultrasonography, computed tomographic angiography and magnetic resonance angiography are the most commonly used diagnostic methods. There are three therapeutic options available: medical therapy including renin-angiotensin-aldosterone system antagonists, lipid-lowering agents, and antiplatelet therapy, percutaneous angioplasty with or without stent placement and surgical revascularization. Three large trials failed to demonstrate the superiority of renal artery revascularization over pharmaceutical therapy in controlling blood pressure and preserving renal function. For this reason, today revascularization is only recommended for patients with progressive worsening of renal function, recurrent 'flash pulmonary edema' and rapid increase in antihypertensive requirement in patients with previously well-controlled hypertension. However, more properly designed trials are needed in order to identify which patient populations would probably benefit from renal revascularization.
肾血管性高血压（RVH）仍然是继发性高血压最常见且重要的病因之一，不过也是潜在可逆转的病因。肾动脉狭窄（RAS）的主要病因是动脉粥样硬化性肾血管动脉狭窄（ARAS）和肾纤维肌发育不良。这种病症可导致进行性肾损伤、心血管并发症以及“闪发性肺水肿”。双功多普勒超声检查、计算机断层血管造影和磁共振血管造影是最常用的诊断方法。有三种治疗选择：药物治疗，包括肾素 - 血管紧张素 - 醛固酮系统拮抗剂、降脂药物和抗血小板治疗；有或无支架置入的经皮血管成形术；以及外科血管重建术。三项大型试验未能证明肾动脉血管重建术在控制血压和保护肾功能方面优于药物治疗。因此，如今血管重建术仅推荐用于肾功能进行性恶化、复发性“闪发性肺水肿”以及既往血压控制良好的患者抗高血压需求迅速增加的情况。然而，需要设计更合理的试验，以确定哪些患者群体可能从肾血管重建术中获益。
