[Renovascular hypertension in children and adolescents: diagnosis and treatment over 19 years]. / Hipertensión vasculo-renal en niños y adolescentes: diagnóstico y tratamiento durante 19 años.

SUMMARY Sixty seven hypertensive children age 2-18 with at least one possible clinical sign of renovascular hypertension (RVH) were enrollment into a screening program for diagnose and treatment of RVH over a 19 year period. Patients underwent a variety of biochemical and imaging studies, but in all cases, renal arteriography was used to determine the precise diagnosis and treatment strategy. Of the 67 patients 21 (31.3%) were identified with renal artery stenosis Group 1, 14 (66.6%) unilateral, 5 (23.8%) bilateral and 2 (9.6%) branches. The mean age was 13.9 +/- 3.73 years, with 26.4 +/- 35.2 months of known hypertension, mean systolic blood pressure 191.1 +/- 30.6 mmHg, mean diastolic blood pressure 135.3 +/- 21.2 mmHg and 69% due to fibromuscular dysplasia. Three therapeutic modalities were chosen: percutaneous transluminal angioplasty (PTA), surgery (autotransplant, and nephrectomy), pharmaceutical therapy with antihypertensive drugs and combination of these. The aim of the treatment was blood pressure control, prevention of chronic renal disease and renal function and organ damage preservation. The outcome was categorized as cure, improvement or no change in hypertension. PTA treated eleven patients, 2 combined with surgery (one nephrectomy and 1 autotransplant). Blood pressure was normalized in 9/11 (81.8%) after a mean follow-up of 11.5 years (range 1-18 years). All 6 RVH cases treated by surgery procedure (one after PTA) were cured and 4 cases were managed medically (pharmacological treatment). On december 2004, 19/21 (90%) RVH adolescents blood pressure was normalized with normal serum creatinina, 10 (48%) of these completed cured, 9/21 (43%) improved (normotensión with decrease in medication requirements) and 2 (9%) other cases ware lost of follow-up. The 46 non-RVH adolescents (68.7%) were treated with long term antihypertensive medications; all of these have adequate BP control and normal renal function. We conclude that our work-up used in order to make a proper and timely diagnosis and treatment of renovascular hypertension in adolescent was successful in our population.

Hipertensión vasculorenal en niños y adolescentes: diagnóstico y tratamiento durante 19 años / Clinical, analytics and imagine studies results in hypertensive adolescents over a 19 years period

En el periodo comprendido desde enero de 1986 hasta diciembre del 2004, se recibieron 67 niños y adolescentes por sospecha de padecer hipertensión vasculo-renal (HTA-VR). Los pacientes fueron sometidos a estudios bioquímicos e imagenológicos, pero en todos los casos la arteriografía por sustracción digitálica (ASD) fue determinante para el diagnóstico y la estrategia de tratamiento. Al concluir el estudio, 21 (31,3%) pacientes (Grupo 1) fueron diagnosticados de HTA-VR por estenosis arterial, 14 (66,7%) unilateral, 4 (19,0%) bilateral y 3 (14,3%) en rama. En el resto de los 46 (68,7%) pacientes (Grupo 2), no se identificó causa etiológica. Grupo I: promedio de edad 13,9 ± 3,7 años, raza blanca 66%, varones 48%, tiempo de hipertensión conocido 26,4 ± 35,3 meses, tensión arterial máxima referida 191 ± 30,5 mmHg para la sistólica y 135 ± 21 mmHg para la diastólica. Grupo 2: promedio de edad 14,7 ± 3,7 años, raza blanca 67%, varones 74%, tiempo de hipertensión conocido 24,2 ± 30,19 meses, tensión arterial máxima referida 163 ± 27,7 mmHg para la sistólica y 108 ± 17 mmHg para la diastólica. La etiología más frecuente de HTAVR fue la displasia fibromuscular 69% de los casos. Se seleccionaron tres modalidades terapéuticas: 1) angioplastia transluminal percutánea (ATP) que se utilizó en 11 pacientes, 2 combinados con cirugía (1 autotrasplante y 1 nefrectomía posterior a trombosis arterial), con 81,8% de control (curado + mejorado) de la hipertensión con un seguimiento promedio de 11,5 años (1 a 18 años); 2) cirugía (autotrasplante o nefrectomía) en 5 casos, más la nefrectomía post-ATP referida, con cura de la hipertensión en todos ellos, y 3) 4 pacientes fueron tratados con hipotensores y diuréticos. En diciembre del 2004, 19/21 (90%) de los pacientes con HTA-VR estaban normotensos con creatinina sérica normal, 10 (48%) curados y 9 (43%) mejorados con algún soporte de hipotensores o diurético), y en 2 (9%) de los pacientes se perdió el seguimiento. Los restantes 46 (68,8%) niños no- HTA-VR tratados, tuvieron adecuado control de la TA con función renal normal. Conclusiones: La pauta de estudio empleada fue útil para el diagnóstico de HTA-VR en nuestro grupo adolescentes hipertensos con signos de clínicos de sospecha de padecer esta entidad. La gammagrafía pre-post-captopril fue la prueba más sensible

Sixty seven hypertensive children age 2-18 with at least one possible clinical sign of renovascular hypertension (RVH) were enrollment into a screening program for diagnose and treatment of RVH over a 19 year period. Patients underwent a variety of biochemical and imaging studies, but in all cases, renal arteriography was used to determine the precise diagnosis and treatment strategy. Of the 67 patients 21 (31.3%) were identified with renal artery stenosis Group 1, 14 (66.6%) unilateral, 5 (23.8%) bilateral and 2 (9.6%) branches. The mean age was 13.9 ± 3.73 years, with 26.4 ± 35.2 months of known hypertension, mean systolic blood pressure 191.1 ± 30.6 mmHg, mean diastolic blood pressure 135.3 ± 21.2 mmHg and 69% due to fibromuscular dysplasia. Three therapeutic modalities were chosen: percutaneous transluminal angioplasty (PTA), surgery (autotransplant, and nephrectomy), pharmaceutical therapy with antihypertensive drugs and combination of these. The aim of the treatment was blood pressure control, prevention of chronic renal disease and renal function and organ damage preservation. The outcome was categorized as cure, improvement or no change in hypertension. PTA treated eleven patients, 2 combined with surgery (one nephrectomy and 1 autotransplant). Blood pressure was normalized in 9/11 (81.8%) after a mean follow-up of 11.5 years (range 1-18 years). All 6 RVH cases treated by surgery procedure (one after PTA) were cured and 4 cases were managed medically (pharmacological treatment). On december 2004, 19/21 (90%) RVH adolescents blood pressure was normalized with normal serum creatinina, 10 (48%) of these completed cured, 9/21 (43%) improved (normotensión with decrease in medication requirements) and 2 (9%) other cases ware lost of follow-up. The 46 non-RVH adolescents (68.7%) were treated with long term antihypertensive medications; all of these have adequate BP control and normal renal function. We conclude that our work-up used in order to make a proper and timely diagnosis and treatment of renovascular hypertension in adolescent was successful in our population

[Atherosclerotic renovascular hypertension: clinical findings and results of treatment over 15 years]. / Hipertensión vasculo-renal aterosclerótica: hallazgos clínicos y resultados del tratamiento durante 15 años.

UNLABELLED: The aim of this study was to present our clinical experience and results of different treatments in 83 atherosclerotic renovascular hypertensive patients treated in the last 15 years in the Instituto de nefrologia in Havana. Regardless of the type of treatment the patients were divided in two groups. Group I: 52 (62.3%) cases with standard oral hypotensive drugs alone and control of other cardiovascular risk factors (mean age 53 years old, sex m/f 50/50%, race white/no-white 75/25%, mean known hypertension follow-up 10.2 +/- 10 years, mean SBP 208 +/- 30 mmHg, mean DBP 123 +/- 17 mmHg, mean serum creatinina 1.62 mg/dl and increase peripheral plasma renin value in 61.6% of patients) and group II: 31 (37.7%) cases treated with revascularización procedures (PTA or surgery) or nephrectomy in selected patients (mean age 50 years old, sex m/f 68/32%, race white/no-white 16/84%, mean known hypertension follow-up 8.5 +/- 8.6 years, mean SBP 214 +/- 32 mmHg, mean DBP 1.31 +/- 16 mmHg, mean serum creatinina 1.85 mg/dl and increase peripheral plasma renin value 78.3% of patients). As end point for treatment results we selected: 1) hypertension cure or control, 2) evolution of the serum creatinine value and 3) kidney and patients survival. RESULTS: In those cases with a follow up for more than one year, in 82.9% the blood pressure was cure (21.4%) or controlled (61.4%). The proportion of failed was superior in group I (20.9%) than in group II (11.1%). All 18 cases treated by PTA with a follow up period longer than a year, blood pressure cure in 10 (55.6%), ameliorate in 5 (27.8%) and in 3 (16.6%) was unchanged (one patient lost of follow up). Nine patients were treated by surgery (3 revascularization and 6 nephrectomy), 5 (55.5%) cases cured and 4 (44.5%) ameliorate his blood pressure. Patients in group II maintain normal renal function in more cases than in group I (48.4% vs 30.8%). Both group had similar percentage of normal-normal + pathology-normal renal function (G I: 65.4% vs G II: 77.4%) p = 0.29. When chronic renal function was present at the base line study none of the revascularization procedure were superior. Patient and Kidney actuarial survivals rate do not showed superiority for any treatment procedure after 10 years of follow up. CONCLUSIONS: In atherosclerosis renovascular hypertension patients treated with intervention procedure had better BP control than those treated by hypotensive drugs. Not significant different between intervention procedures and drugs treatment in renal function preservation or in patient and kidney actuarial survival rate were found in these patients.

[Arterial hypertension in Cuba. General overview of the past 25 years]. / Hipertensión arterial en Cuba. Panorámica general de los últimos 25 años.

A general overview of hypertension as a major health problem in Cuba in the last 25 years are presented. In the first period, 1974-1990 was created a National Hypertension High Commission by the Minister of Public and the First national program for prevention and Control of Hypertension in Cuba was launched. To define high blood pressure in adults 15 years and older the cut-off point was set at 160/95 mmHg. The prevalence found was 15% in urban areas and 7-8% in rural areas. The second period, 1991-1998 the original National program was re-evaluated in 1990 and 1995. The new blood pressure cut-off point was set at 140/90 mmHg. The prevalence increased to 30.6% in urban areas and 15% in rural areas and incidence of 2.5% annual. A total of 862,303 hypertensive patients were registry at the end of 1997 which represents less than 40% of the total number of possible hypertensive patients. A National Campaign was launched in 1998. In 9 months the preliminary reports were: 25% increase in prevalence, registry and follow-up of hypertensive patients 15 years old and older (8.5% to 12.5%); 92.9% of primary care doctors and 89.5% of primary care nurses received training; improvement in public education and social support; improvement in risk factor awareness in general public and improvement of hypotensive drugs availability and splygmomanometers supplies.