Cerebrovascular Diseases
Original Paper
Management of Resistant Hypertension in Patients with Carotid Stenosis: High Prevalence of Renovascular HypertensionSpence J.D.Stroke Prevention and Atherosclerosis Research Centre, Siebens-Drake/Robarts Research Institute, London, Ont., Canada
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Article / Publication Details
Published online: June 22, 2000
Issue release date: July – August
Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 3
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
Abstract
Introduction: 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. Objective: The purpose of this study was to determine the prevalence of resistant hypertension and of secondary hypertension among patients with carotid stenosis. Methods: 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. Results: 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). Conclusion: 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.
© 2000 S. Karger AG, Basel
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References
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External Resources
- Wallach L, Nyarai I, Dawson KG: Stimulated renin: A screening test for hypertension. Ann Intern Med 1975;82:27–35.
- Lamki L, Spence JD, MacDonald AC, Roulston M: Differential glomerular filtration rate in diagnosis of renovascular hypertension and follow-up of balloon angioplasty. Clin Nucl Med 1986;11:188–193.
- Spence JD: Physiologic tailoring of therapy for resistant hypertension: 20 year’s experience with stimulated renin profiling. Am J Hypertens 1999;12:1077–1083.
- Spence JD: Government guidelines for hypertension. Am J Hypertens 1995;8:541.
Article / Publication Details
Published online: June 22, 2000
Issue release date: July – August
Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 3
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
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