[Takayasu's arteritis: underestimated cause of hypertension].
Takaysu's arteritis (TA) is regarded to be a frequent cause of hypertension in Asian population. However some reports have recently informed about increasing frequency of its also in non Asian people. The aim of this study was to evaluated own experiences on diagnosis and treatment of TA as well as prevalence of TA in hypertensive patients in Caucasian population.


METHODS
During last 15 years we examined 4190 hypertensive patients hospitalized in our department. Renovascular hypertension was recognized in 139 cases. The diagnosis of TA was based on angiographically proven vascular changes and its inflammatory phase on estimation increased (> 40 mm/h) sedimentation rate and immunoglobulins above normal level. The patients with acute phase of TA initially received typical immunosuppressive therapy (prednisone in monotherapy or combined with azatioprine or cyclophosphamide), followed by chronic administration of prednisone. In every case, if it was possible, we proposed angio-corrective procedure. All patients have received hypotensive and antiplatelet therapy.


RESULTS
TA was recognized in 15 patients--4 men and 11 women, average age 36.3 +/- 9.8 y. The patients with TA represented 0.37% hypertensive and 10.9% cases of renovascular hypertension. Significant stenosis of renal artery and various degree of lesions in aorta and some arteries was discovered in all persons. In the observed group hypertension was effectively controlled with 2-3 hypotensive drugs, including ACE inhibitors, diuretics and Ca antagonists. The acute phase of TA was diagnosed in 11 patients and it was treated successfully (except one case) with immunosuppressive therapy. After discontinuation of the treatment (4 patients) progression of the disease was observed. In 6 patients, characterised by clinical and biochemical remission of acute phase percutaneous angioplasty renal artery was performed. A good result in long-term follow-up period was observed in 4 cases (in 2 after repeated procedure). Surgical procedure was performed in 4 cases--in 2 on carotid and in 1 on renal and the next one on coronary artery. In first 3 cases the procedures were unsuccessful (reocclusion ?).


CONCLUSIONS
Our observation suggested that 1. The incidence of TA in hypertensive (especially renovascular hypertension) population is more frequent than expected. 2. Acute phase of the disease is indication to long-term the immunosuppressive therapy. 3. Angiocorrective procedure is necessary reflected in every case in period of remission of acute phase.
Cybulska
I
I
Klinika Nadciśnienia Tetniczego Instytut Kardiologii Alpejska 42, 04-628 Warszawa.
Makowiecka-Cieśla
M
M
Florczak
E
E
D000293:Adolescent; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D013625:Takayasu Arteritis / Q000150:complications* / Q000188:drug therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D000893:Anti-Inflammatory Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D011239:Prednisolone