Refractory hypertension caused by renal artery fibromuscular dysplasia in one child / 临床儿科杂志

Objective To explore the clinical characteristics, diagnosis and treatment of refractory hypertension caused by renal artery fibromuscular dysplasia (FMD) in children. Method The clinical data of a child with refractory hypertension caused by FMD were retrospectively analyzed. Results A boy, with onset at age of 4 years, had significantly increased blood pressure and decreased serum potassium. His renin and angiotensin levels were significantly elevated. The boy was diagnosed with renovascular hypertension by color Doppler ultrasonography, enhanced thoracoabdominal CT and vascular reconstruction. Oral administration of a variety of antihypertensive drugs is not effective. The child was finally diagnosed of refractory hypertension caused by FMD using renal angiography. The child was not suitable for surgery. After adjusting the antihypertensive drugs, the blood pressure of the child tended to be stable. The boy received continuous follow-up for 8 years. The antihypertensive regimen was adjusted annually and blood pressure fluctuations and target organ damage were dynamically assessed. Conclusion Children with FMD caused renal vascular hypertension may have no specific manifestations in the early stage. The drug treatment is preferred, and surgical treatment may be considered.

Chronic Intermittent Hypobaric Hypoxia Ameliorates Renal Vascular Hypertension Through Up-regulating NOS in Nucleus Tractus Solitarii / 神经科学通报·英文版

Chronic intermittent hypobaric hypoxia (CIHH) is known to have an anti-hypertensive effect, which might be related to modulation of the baroreflex in rats with renal vascular hypertension (RVH). In this study, RVH was induced by the 2-kidney-1-clip method (2K1C) in adult male Sprague-Dawley rats. The rats were then treated with hypobaric hypoxia simulating 5000 m altitude for 6 h/day for 28 days. The arterial blood pressure (ABP), heart rate (HR), and renal sympathetic nerve activity (RSNA) were measured before and after microinjection of L-arginine into the nucleus tractus solitarii (NTS) in anesthetized rats. Evoked excitatory postsynaptic currents (eEPSCs) and spontaneous EPSCs (sEPSCs) were recorded in anterogradely-labeled NTS neurons receiving baroreceptor afferents. We measured the protein expression of neuronal nitric oxide synthase (nNOS) and endothelial NOS (eNOS) in the NTS. The results showed that the ABP in RVH rats was significantly lower after CIHH treatment. The inhibition of ABP, HR, and RSNA induced by L-arginine was less in RVH rats than in sham rats, and greater in the CIHH-treated RVH rats than the untreated RVH rats. The eEPSC amplitude in NTS neurons receiving baroreceptor afferents was lower in the RVH rats than in the sham rats and recovered after CIHH. The protein expression of nNOS and eNOS in the NTS was lower in the RVH rats than in the sham rats and this decrease was reversed by CIHH. In short, CIHH treatment decreases ABP in RVH rats via up-regulating NOS expression in the NTS.

Difference analysis of ambulatory blood pressure and dynamic ECG in patients with renovascular hypertension and essential hypertension / 中国现代医生

Objective To observe the difference of ambulatory blood pressure and dynamic ECG in patients between renal vascular hypertension(RVH) and essential hypertension(EH). Methods Randomly selected 45 RVH patients and 45 EH patients with matched age and gender, monitored the ambulatory blood pressure and dynamic ECG of both group in 24 hours, and the difference was analyzed from October 2011 to September 2015 in our hospital. Results The 24 h average systolic blood pressure (SBP),diastolic blood pressure (DBP),night and daytime average SBP and DBP RVH patients were higher than those of EH group (P<0.05);Blood pressure load of RVH patients was higher than that of EH group (P<0.05),especially the nocturnal SBP. Arrhythmia and incidence of ST-T segment depression in RVH patients were higher than those in EH patients(P<0.05). Conclusion RVH patients have higher dynamic BP,BP loads and blunted diurnal rhythm compared to EH patients, and there is relevance between ECG and blood pressure values of patients.

Renal vascular hypertension

This is a report of 7 cases of renal vascular hypertension. In 4 of these 7 cases, the diagnosis was not even thought of and was made only at autopsy. Among the three correctly diagnosed patients, one was a 26 year-old woman with an aneurysm of the left renal artery which was resected followed by renal artery replacement with a Dacron prosthesis graft with alleviation of her hypertension. The second was a 20 year-old female medical student with extreme hypoplasia at the left renal artery and kidney. Nephrectomy cured her hypertension. The third was a 19 year-old female with bilateral renal artery obstruction at their origins from the aorta. Surgical relief was obtained by endarterectomy and widening of renal artery origin using Dacron patchesThe clinical picture, useful laboratory aids, indications for aortography, surgical anatomy, physiology, surgical procedures, histology, and results of others are cited and discussed. (Summary)