Youngberg S P, Sheps S G, Strong C G
Am Heart J. 1977 Dec;94(6):785-94. doi: 10.1016/s0002-8703(77)80222-6.
Renal artery stenosis, either fibromuscular or atheromatous, is probably the most common cause of secondary hypertension in man. Both of these diseases are active, ongoing processes that may be ameliorated but not cured by medical or surgical treatment. The clinical history and examination of the patient with hypertension may help differentiate renovascular hypertension from essential hypertension. The presence of a systolic-diastolic or continuous bruit is often an indicator of severe renal artery stenosis. Systemic hypertension is the physiologic consequence of significant renal artery stenosis. Knowledge of the basic concepts of the renin-angiotensin-aldosterone system, as has evolved from experimental models of renovascular hypertension, forms the basis for understanding the process of evaluation and treatment of such patients. The treatment of choice for the patient with severe hypertension and a functionally significant renovascular lesion is surgical--both in terms of successful treatment of hypertension and improved long-term prognosis. Diligent periodic reevaluation of these patients as well as those with less severe hypertension who are receiving medical treatment enables the physician to select the proper management that offers optimal control of patient blood pressure and avoids target-organ damage to the kidneys, central nervous system, or cardiovascular system.
肾动脉狭窄，无论是纤维肌性的还是动脉粥样硬化性的，可能是人类继发性高血压最常见的病因。这两种疾病都是活跃的、持续进展的过程，药物或手术治疗可能会使其改善，但无法治愈。高血压患者的临床病史和检查有助于区分肾血管性高血压和原发性高血压。收缩期-舒张期或连续性杂音的存在通常提示严重的肾动脉狭窄。全身性高血压是显著肾动脉狭窄的生理后果。从肾血管性高血压实验模型发展而来的肾素-血管紧张素-醛固酮系统的基本概念，构成了理解此类患者评估和治疗过程的基础。对于重度高血压且存在功能上显著的肾血管病变的患者，首选的治疗方法是手术——这在成功治疗高血压以及改善长期预后方面均有优势。对这些患者以及接受药物治疗的轻度高血压患者进行定期的仔细重新评估，能使医生选择合适的治疗方案，以最佳地控制患者血压，并避免对肾脏、中枢神经系统或心血管系统造成靶器官损害。
