[The x-ray endovascular treatment of renin-dependent arterial hypertension with secondary aldosteronism in patients without vasorenal involvement].
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.
Mazo
E B
EB
Akopian
A S
AS
Anakhasian
R V
RV
Koriakin
M V
MV
Andrianov
V N
VN
D000311:Adrenal Glands / Q000098:blood supply / Q000000981:diagnostic imaging; D000328:Adult; D002216:Captopril; D002406:Catheterization, Peripheral / Q000379:methods; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006973:Hypertension / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006978:Hypertension, Renovascular; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D015641:Radiography, Interventional / Q000379:methods*; D012074:Remission Induction; D012083:Renin / Q000097:blood*; D014680:Veins / Q000601:surgery
D002216:Captopril; D012083:Renin
Rentgenoéndovaskuliarnoe lechenie reninzavisimoĭ arterial'noĭ gipertenzii s vtorichnym al'dosteronizmom u bol'nykh bez vazorenal'nogo porazheniia.