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Abstract: FR-PO1057

Management of Resistant Hypertension due to Renal Artery Stenosis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Author

  • Zhao, Jinhua, Cleveland VA Medical Center, Cleveland, Ohio, United States
Introduction

Medical management of secondary hypertension caused by renal artery stenosis (RAS) remains mainstream especially after the publication of Coral Study. Coral Study suggested no difference in blood pressure (Bp) control between medical management alone and medical management plus percutaneous intervention. Some patients’ clinical picture does not fit in the inclusion criteria of Coral Study, the management should be individualized.

Case Description

A 68-year-old white male with uncontrolled HTN on 5 antihypertensives, HLD, T2DM, CKD Stage 3-4. His antihypertensive medications include: amlodipine 10mg daily, Chlorthalidone 25mg daily, hydralazine 50mg 3 times a day, terazosin 5mg daily at bedtime, and clonidine 0.3mg twice a day. Patient was briefly on lisinopril which was stopped after patient developed acute renal failure with hyperkalemia. His Bp had been 180-210’s/80-90’s for most time. Our work-up was significant for renin activity 27.36 ng/ml/h, serum aldosterone 5.9 ng/DL. Renal US showed right kidney 10.2cm, left kidney 7.4cm. Angiography showed severe narrowing at the right renal artery orifice which has early bifurcation, involving the upper and lower branches. Left renal arteriogram: A small accessory lower pole left renal artery is visualized with complete occlusion of the main left renal artery. Renal vein sampling was done 3 days later. Renin activity of left renal vein was 30.62, whereas that of the right renal vein was 117.05, that of inferior vena cava was 41.85. Thus the decision was to re-vasculize the right renal artery in 1 week to avoid repeated iv contrast exposure in very short time. Placement of 6 mm x 18 mm balloon expandable stent in the dominant branch of the right renal artery was done. Patient’s systolic Bp was 140-160’s mmHg one month later on only lisinopril 2.5mg daily. His Bp were ~ 130/70 mmHg one year later on lisinopril 10mg daily.

Discussion

The management of resistent hypertension due to renal artery stenosis needs to be individualized.