Published online before print October 21, 2002, doi: 10.1161/01.HYP.0000037218.09310.81
(Hypertension. 2002;40:595.)
© 2002 American Heart Association, Inc.
Hypertension Grand Rounds |
Progressive Hypertension in a Patient With "Incidental" Renal Artery Stenosis
From the Divisions of Hypertension and Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Correspondence to Stephen C. Textor, MD, Divisions of Hypertension and Nephrology, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail textor.stephen@mayo.edu
Key Words: angioplasty • angiotensin-converting enzyme • hypertension, renovascular • renal artery
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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A 63-year-old man was referred for progressive hypertension and previously identified, incidental renal artery stenosis. Three years earlier, he underwent a 4-vessel coronary artery bypass (CABG). A year later, recurrent chest symptoms led to repeat coronary angiography, which identified patent bypass grafts except for one vein-graft occlusion. No coronary interventional procedures were undertaken. During catheter withdrawal, an aortogram revealed bilateral renal artery stenosis estimated to be "greater than 70% luminal stenosis." Serum creatinine was 1.3 mg/dL. Blood pressure was 120/70 mm Hg. Medications consisted of daily administration of atenolol 50 mg, atorvastatin 10 mg, and aspirin 81 mg. There was no other history of atherosclerotic events, including stroke or peripheral vascular disease. No renal interventional procedures were undertaken.
Three months before the present referral, this man developed exertional chest discomfort after walking 6 blocks and several brief episodes of supraventricular tachycardia. These events terminated after adenosine administration during emergency room visits. Blood pressures were between 180 and 200/90 mm Hg, for which amlodipine was added to the patient’s regimen. Thallium stress testing demonstrated a small apical area of ischemia. He was offered radio-frequency ablation therapy for nodal re-entry tachycardia.
Hypertension consultation was obtained. The patient described recent awareness of head discomfort, particularly during the morning hours. Home blood pressure readings ranged between 155/90 and 170/95 mm Hg, whereas readings had been in the 125/70 mm Hg range before. He had discontinued smoking 5 years earlier. Office blood pressures now were 205/108 mm Hg. Arteriovenous nicking was present. No bruits were
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V. D. Garovic and S. C. Textor Renovascular Hypertension and Ischemic Nephropathy Circulation, August 30, 2005; 112(9): 1362 - 1374. [Full Text] [PDF]
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