Document Detail


Management of resistant hypertension in patients with carotid stenosis: high prevalence of renovascular hypertension.
MedLine Citation:
PMID:  10878428     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Patients with carotid stenosis are at high risk of vascular events and therefore require an optimal control of risk factors such as hypertension. As the treatment of hypertension differs according to the cause, we examined the prevalence of resistant hypertension, and the cause of hypertension, among patients with carotid stenosis followed closely in two randomized trials of carotid endarterectomy. OBJECTIVE: The purpose of this study was to determine the prevalence of resistant hypertension and of secondary hypertension among patients with carotid stenosis. METHODS: A chart review was performed of all patients from our center who participated in the North American Symptomatic Carotid Endarterectomy Trial or the Asymptomatic Carotid Artery Study to determine the prevalence of renovascular hypertension. RESULTS: Among 170 patients with carotid stenosis followed in these two trials, 145 (83.5%) were hypertensive (systolic >160 or diastolic >90 mm Hg); at least 24 (14.1% overall, 16.6% of hypertensives) had renovascular hypertension based on either nuclear medicine renography, renal angiography or both; among the 79 patients with resistant hypertension (mean arterial pressure >130 mm Hg despite treatment), 20 (25.3%) had renovascular hypertension. Adrenocortical hyperplasia was the underlying cause of hypertension in 12 (7.1% of cases, 8.3% of hypertensives, 8.8% of resistant hypertensives). Blood pressures were significantly higher for patients with renovascular and adrenocortical hypertension (p < 0.0001 for systolic, p = 0.024 for diastolic pressures). CONCLUSION: Among patients with carotid stenosis, renovascular hypertension is unusually common. Resistant hypertension among such patients should lead to investigation and management directed at the cause of hypertension. Appropriate investigations might include plasma renin/aldosterone ratio, captopril renography and MRA of the renal arteries or renal angiography.
Authors:
J D Spence
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  10     ISSN:  1015-9770     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:    2000 Jul-Aug
Date Detail:
Created Date:  2000-08-24     Completed Date:  2000-08-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  249-54     Citation Subset:  IM    
Copyright Information:
Copyright 2000 S. Karger AG, Basel
Affiliation:
Stroke Prevention and Atherosclerosis Research Centre, Siebens-Drake/Robarts Research Institute, London, Ont., Canada. dspence@rri.on.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty
Antihypertensive Agents / therapeutic use
Arteriosclerosis / drug therapy,  epidemiology,  surgery
Carotid Stenosis / epidemiology*,  surgery
Endarterectomy, Carotid
Female
Follow-Up Studies
Humans
Hypertension, Renal / drug therapy*,  epidemiology*,  surgery
Male
Middle Aged
Prevalence
Randomized Controlled Trials as Topic
Retrospective Studies
Stroke / epidemiology
Grant Support
ID/Acronym/Agency:
R01 NS24456-11/NS/NINDS NIH HHS; R01 NS34447/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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