Hypertension and End-Stage Renal Disease

Hypertension, or high blood pressure, affects an estimated 10-25 percent of the population of the United States. Most people can be treated with medication, but a subset of this group-3 to 8-percent have hypertension that is caused by vascular disease, i.e., arterial blockage or narrowing in the renal artery. This renovascular disease causes decreased blood flow to the kidney, which results in systemic (body-wide) constriction of the blood vessels, causing a rise in blood pressure. This hypertension in the renal blood vessels may occur while the systemic blood pressure remains normal, making it difficult to detect.

Renal Hypertension-A Major Cause of End-stage Renal Disease

Renal hypertension puts stress and increased pressure on the kidney, and is a major cause of end-stage renal disease, also known as chronic renal disease, in the elderly. Vascular disease, also known as atherosclerosis, is prevalent in the United States, and as the population ages, the number of people with vascular disease will increase. So too will the number with renovascular hypertension and end-stage renal disease. People with end-stage renal disease require dialysis or kidney transplantation.

Renovascular hypertension should be suspected when the onset of hypertension occurs before age 30 or after age 50, or when stable hypertension becomes more difficult to control with medication. White males and blacks of both sexes are at higher risk and people over 50 are at higher risk.

Diagnosis and Treatment

With imaging studies and biochemical work-up, interventional radiologists can accurately diagnose renovascular disease. If medical management-medications and lifestyle changes-are insufficient, interventional radiologists can perform angioplasty and, if needed, stenting, to improve blood flow to the kidney. The goal of the treatment in renovascular disease is normalization of the blood pressure or improvement of its control with medications, and improvement or preservation of kidney function. Angioplasty of the renal artery is relatively low risk and can greatly improve blood pressure control and thus prevent further damage to the kidney. Balloon angioplasty and stenting has generally replaced surgery as the first-line treatment for renal arterial occlusions.

Complications of Renovascular Hypertension

• Early death
• Hypertensive heart disease
• Myocardial infarction
• Congestive heart failure
• Renal insufficiency or failure
• Stroke

Treatments include Angioplasty and Stenting.