Renovascular Hypertension: Diagnosis and Treatment of Renal Artery Stenosis (literature review and description of a clinical case)

Introduction. Recently, the detection of secondary, symptomatic arterial hypertension, which is due to the introduction of more advanced research methods, has become more frequent. The frequency of secondary forms of arterial hypertension is 5.0-25.0 % of the total number of cases of elevated blood pressure. One of the most common secondary forms of the arterial hypertension, especially in young people, is vasorenal arterial hypertension (VAH), the etiological factor of which is the uni- or bilateral stenosis of renal artery defects (congenital or acquired). The frequency of VAH among all the patients with hypertension is 1.0-5.0 %. Aim. To make an overview of modern literature on the problem of VAH: diagnosis and treatment of renal artery stenosis and to describe a clinical case. Materials and methods. A bibliosemantic method is used to study the relevant scientific research concerning the problem of vasorenal hypertension: diagnosis and treatment of renal artery stenosis. The clinical case of an early detection and diagnosis of the renovascular hypertension caused by the right renal artery stenosis is described according to the results of the basic and additional examination methods. Results. A standard examination of a patient with stable arterial hypertension of the III grade did not detect the lesions of the target organs (heart, retina, brain, kidneys) and did not allow to find out the cause of arterial hypertension.The results of multislice computed tomography of the abdomen with the contrast enhancement proved to be the most informative in case of the determining the cause of vasorenal hypertension – stenosis of the right renal artery by 72.0 %, which, due to the young age, was probably due to fibromyamic dysplasia. In addition, the patient was diagnosed with congenital S-shaped deviation of both internal carotid arteries and cyst of the epithis. So, in the absence of lesions of target organs, after the adequate correction of elevated pressure (ebrantil (urapidil) 30.0 mg twice daily, thiazide diuretic – hypothiazide – 50.0 mg per day), the planned reimplantation of the right renal artery, the young woman fully recovered, did not lose capacity for work. In the postoperative period, the level of blood pressure without the use of antihypertensive drugs decreased and stabilized at 120/80 mm Hg. Conclusions. Resistant arterial hypertension in young people is the cause for providing of magnetic resonance tomography of the brain, spine and multi-spinal computer tomography of the abdominal cavity. Adequately chosen method of the surgical treatment for the patient made it possible to normalize the blood pressure.