[The x-ray endovascular treatment of renin-dependent arterial hypertension with secondary aldosteronism in patients without vasorenal involvement]. / Rentgenoéndovaskuliarnoe lechenie reninzavisimoi arterial'noi gipertenzii s vtorichnym al'dosteronizmom u bol'nykh bez vazorenal'nogo porazheniia.

In 20% of cases, essential hypertension is of high renin pathogenesis which is indifferent of that of renal lesions. In these patients high blood pressure is closely related to high aldosterone generation due to elevated angiotensin II levels. Adrenal blood portalization is a possible way of abolishing secondary aldosteronism and hyperreninemia in this case. With this, 90-98% aldosterone and 20-30% renin are inactivated, which served as the basis for bilateral electrocoagulation of adrenal central veins in 13 patients with permanent and malignant arterial hypertension. The renin-dependent pattern of essential hypertension was confirmed by a positive BP response to a tested captopril dose (25 mg), the vasorenal one was ruled out on the basis of the peripheral captopril test, captopril pharmacorenography. Bilateral electrocoagulation of adrenal central veins was performed during a phlebographic examination. The manipulation proved to be successful on 11 (85%) left and 9 (70%) right adrenals. Blood pressure became lower in the first day and stable on days 4-5. There was a significant decrease in blood pressure at a year follow-up, in increased aldosterone levels, plasma renin activity with unchanged adrenocorticotropic hormone concentrations. After the manipulation, 2 patients refused to take antihypertensive drugs, 11 patients received lower doses of drugs. The method for abolishing secondary aldosteronism is considered to be promising for further clinical studies. A special attention should be given to patients with diseases concomitant with essential hypertension who have no alternative to surgical treatment.

[Diagnosis and roentgeno-endovascular treatment of patients with renin-dependent arterial hypertension and secondary aldosteronism without damage to the main renal arteries]. / Diagnostika i rentgenoéndovaskuliarnoe lechenie bol'nykh reninzavisimoi arterial'noi gipertenziei so vtorichnym al'dosteronizmom bez porazheniia magistral'nykh arterii pochek.

Bilateral electrocoagulation of the central veins of the adrenals (ECVA) was performed in 13 patients with stable and malignant arterial hypertension (AH). The renin-dependent character of AH was supported by positive reaction of arterial pressure (AP) to the test dose of captopril (25 mg). The vasorenal origin of the impairment was excluded on the basis of the peripheral captopril test findings, pharmacorenography with captopril. Bilateral ECVA was done during angiography. The manipulation turned out technically successful in 11 left (85%) and 9 right (70%) adrenals. The AP began lowering from the first days of the intervention and got stabilized by day 4 to 5. There was a significant decline of AP within the observation period up to 1 year and a reduction of the elevated aldosterone content and plasma renin activity with the content of ACTH being unchanged. After the manipulation 2 patients could fully discontinue the intake of hypotensive drugs. In 11 patients, the dose of the drugs could be reduced.