Renal Hypertension
Disease Details
Family Health Simplified
- Description
- Renal hypertension, also known as renovascular hypertension, is high blood pressure caused by narrowing of the arteries that supply blood to the kidneys.
- Type
- Renal hypertension, also known as renovascular hypertension, is typically not directly inherited in a simple Mendelian pattern. However, it can be associated with underlying conditions that have a genetic component, such as fibromuscular dysplasia or certain forms of congenital renal artery stenosis. These conditions may show a familial pattern, suggesting a possible genetic predisposition.
- Signs And Symptoms
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Symptoms of renovascular hypertension include the following:
High blood pressure (early age)
Kidney dysfunction
Narrowing of arteries elsewhere in the body
Pulmonary edema - Prognosis
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The prognosis of individuals with renovascular hypertension is not easy to determine. Those with atherosclerotic renal artery disease have a high risk of mortality, furthermore, those who also have renal dysfunction have a higher mortality risk.
However, the majority of renovascular diseases can be improved with surgery. - Onset
- Renal hypertension, also known as renovascular hypertension, typically has an insidious onset, meaning it develops gradually and without obvious symptoms in the early stages.
- Prevalence
- The prevalence of renal hypertension, also known as renovascular hypertension, varies widely depending on the population studied. It is estimated to account for about 1-5% of all cases of hypertension. However, in individuals with severe, resistant, or malignant hypertension, the prevalence can be higher, around 10-45%.
- Epidemiology
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Renal hypertension, also known as renovascular hypertension, is a type of high blood pressure caused by narrowing of the arteries that supply the kidneys (renal arteries). This condition is relatively rare compared to essential hypertension, which has no identifiable cause.
Epidemiology:
- Renal hypertension accounts for about 1-5% of all cases of hypertension.
- It is more commonly seen in older adults, particularly those with a history of atherosclerosis.
- Men are slightly more affected than women due to higher rates of atherosclerosis.
- People with fibromuscular dysplasia, a condition that affects the blood vessels, are also at increased risk, and this tends to occur more in younger women.
Nan: This input does not provide additional context or information relevant to the epidemiology of renal hypertension. - Intractability
- Renal hypertension, also known as renovascular hypertension, can sometimes be difficult to manage, especially if it is caused by underlying conditions such as renal artery stenosis. However, it is not considered intractable in all cases. Treatment options such as medication, lifestyle changes, and sometimes surgical interventions, like angioplasty or stenting, can effectively manage and control blood pressure. The intractability depends on the underlying cause and the patient's individual response to treatments.
- Disease Severity
- Renal hypertension, also known as renovascular hypertension, can vary in severity based on the underlying cause and the extent of kidney involvement. It is typically caused by narrowing of the arteries that supply the kidneys (renal artery stenosis), leading to high blood pressure. If left untreated, it can result in severe complications such as chronic kidney disease, heart attack, stroke, or heart failure. Timely diagnosis and treatment are crucial to managing the severity and preventing long-term damage.
- Healthcare Professionals
- Disease Ontology ID - DOID:1073
- Pathophysiology
- Renal hypertension, also known as renovascular hypertension, primarily results from the narrowing of the arteries that supply the kidneys (renal artery stenosis). This decreases blood flow to the kidneys, causing them to respond as if there is a systemic decrease in blood pressure. The kidneys then activate the renin-angiotensin-aldosterone system (RAAS), leading to the release of renin, an enzyme that converts angiotensinogen to angiotensin I. Angiotensin I is subsequently converted to angiotensin II, a potent vasoconstrictor, which raises blood pressure by constricting blood vessels and stimulating aldosterone secretion from the adrenal glands. Aldosterone increases sodium and water reabsorption in the kidneys, further elevating blood volume and blood pressure. This maladaptive response perpetuates hypertension, contributing to a cycle of worsening renal artery stenosis and elevated blood pressure.
- Carrier Status
- Renal hypertension, also known as renovascular hypertension, is primarily caused by narrowing of the arteries that supply the kidneys (renal artery stenosis), leading to increased blood pressure. It does not have a "carrier status" as it is not an inherited genetic condition. Instead, it results from structural issues in the renal arteries, often due to atherosclerosis or fibromuscular dysplasia.
- Mechanism
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Renal hypertension, also known as renovascular hypertension, is high blood pressure caused by the narrowing of arteries that carry blood to the kidneys (renal artery stenosis).
**Mechanism:**
Narrowed arteries reduce blood flow to the kidneys. In response, the kidneys interpret this decreased blood flow as low blood pressure and activate the renin-angiotensin-aldosterone system (RAAS) to increase blood pressure and restore what they perceive as normal renal perfusion.
**Molecular Mechanisms:**
1. **Renin Release:** The juxtaglomerular cells of the kidneys release renin in response to reduced renal perfusion.
2. **Angiotensin II Production:** Renin converts angiotensinogen (produced by the liver) into angiotensin I, which is then converted into angiotensin II by the angiotensin-converting enzyme (ACE) primarily in the lungs. Angiotensin II is a potent vasoconstrictor, which increases systemic vascular resistance and blood pressure.
3. **Aldosterone Secretion:** Angiotensin II stimulates the secretion of aldosterone from the adrenal cortex, which increases sodium and water reabsorption in the kidneys. This increases blood volume, contributing to higher blood pressure.
4. **Sympathetic Nervous System Activation:** Angiotensin II also activates the sympathetic nervous system, further contributing to vasoconstriction and increased cardiac output.
These molecular mechanisms result in sustained high blood pressure, characteristic of renal hypertension. - Treatment
- In terms of treatment for renovascular hypertension surgical revascularization versus medical therapy for atherosclerosis, it is not clear if one option is better than the other according to a 2014 Cochrane review; balloon angioplasty did show a small improvement in blood pressure .Surgery can include percutaneous surgical revascularization, and also nephrectomy or autotransplantation, and the individual may be given beta-adrenergic blockers. Early therapeutic intervention is important if ischemic nephropathy is to be prevented. Inpatient care is necessary for the management of hypertensive urgencies, quick intervention is required to prevent further damage to the kidneys.
- Compassionate Use Treatment
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Compassionate use treatment involves providing patients with severe or life-threatening conditions access to investigational drugs outside of clinical trials when no comparable or satisfactory alternative therapy options exist. For renal hypertension, there may be compassionate use of experimental drugs particularly in cases where conventional treatments are ineffective.
Off-label treatments refer to the use of approved drugs for an unapproved condition or in an unapproved age group, dosage, or route of administration. In renal hypertension, some drugs approved for general hypertension or other cardiovascular conditions might be used off-label, such as aldosterone antagonists or different combinations of antihypertensive medications.
Experimental treatments can include various investigational drugs or procedures currently being studied in clinical trials. This could involve novel antihypertensive agents, renal denervation methods, or gene therapy approaches aimed at addressing the underlying causes of renal-induced hypertension. Participation in clinical trials is often required to access these experimental options. - Lifestyle Recommendations
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For renal hypertension, which is high blood pressure due to kidney issues, the following lifestyle recommendations are often suggested:
1. **Dietary Changes**:
- Reduce sodium intake by avoiding processed and high-salt foods.
- Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.
- Limit alcohol consumption.
2. **Regular Exercise**:
- Engage in moderate physical activity, like walking, swimming, or cycling, for at least 150 minutes per week.
- Include strength training exercises twice a week.
3. **Weight Management**:
- Maintain a healthy weight through a combination of diet and exercise, as obesity can worsen hypertension.
4. **Stress Management**:
- Practice stress-relief techniques such as meditation, deep breathing exercises, yoga, or tai chi.
- Ensure adequate sleep and establish a consistent sleep schedule.
5. **Avoid Smoking**:
- Quit smoking as it can exacerbate hypertension and cause additional kidney damage.
6. **Regular Monitoring and Medical Follow-up**:
- Regularly check blood pressure at home and keep scheduled visits with healthcare providers.
- Follow prescribed medication regimens diligently.
7. **Hydration**:
- Stay well-hydrated but manage fluid intake as advised by your healthcare provider, especially if there are specific kidney function concerns.
These recommendations should be tailored to the individual’s health conditions and discussed with a healthcare provider for optimal management. - Medication
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Medications commonly used to manage renal hypertension (hypertension caused by kidney disease) include:
1. **Angiotensin-converting enzyme (ACE) inhibitors**: Such as lisinopril, enalapril, and ramipril.
2. **Angiotensin II receptor blockers (ARBs)**: Such as losartan, valsartan, and irbesartan.
3. **Diuretics**: Such as hydrochlorothiazide, furosemide, and spironolactone.
4. **Calcium channel blockers**: Such as amlodipine, nifedipine, and diltiazem.
5. **Beta-blockers**: Such as atenolol, metoprolol, and propranolol.
6. **Renin inhibitors**: Such as aliskiren.
These medications help control blood pressure and can also provide kidney protection. Treatment plans are tailored to individual patient needs based on their overall health and the severity of their condition. - Repurposable Drugs
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Renal hypertension, also known as renovascular hypertension, is often caused by narrowing of the arteries that carry blood to the kidneys. Several repurposable drugs originally approved for other uses may be effective in treating this condition. These include:
1. **ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)** like captopril and enalapril: Initially used for general hypertension and heart failure, these drugs can help relax blood vessels and reduce blood pressure.
2. **ARBs (Angiotensin II Receptor Blockers)** such as losartan and valsartan: Also used for general hypertension and diabetic nephropathy, ARBs are an alternative to ACE inhibitors for patients who cannot tolerate them.
3. **Calcium Channel Blockers** including amlodipine and nifedipine: These medications, used for managing high blood pressure and angina, can help relax the muscles of the heart and blood vessels.
4. **Beta-Blockers** like propranolol and metoprolol: Initially used for heart conditions and hypertension, beta-blockers can reduce the heart rate and the force of contraction, thereby lowering blood pressure.
5. **Diuretics** such as hydrochlorothiazide and furosemide: Often used in managing hypertension and edema, diuretics help the kidneys remove excess fluid and salt from the body, reducing blood pressure.
These drugs can be part of the therapeutic strategy for managing renal hypertension, but their use should be monitored by a healthcare provider to ensure safety and efficacy. - Metabolites
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For renal hypertension (also known as renovascular hypertension), metabolites that may be involved include:
1. Angiotensin II: A critical peptide in the renin-angiotensin-aldosterone system (RAAS), which plays a central role in blood pressure regulation.
2. Aldosterone: A hormone that increases sodium reabsorption in the kidneys, contributing to elevated blood pressure.
3. Renin: An enzyme secreted by the kidneys that initiates the conversion of angiotensinogen to angiotensin I.
Levels of these metabolites are commonly evaluated in patients with renal hypertension to understand the underlying pathophysiological mechanisms. - Nutraceuticals
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Nutraceuticals for renal hypertension include dietary supplements and functional foods that can help manage blood pressure and support kidney function. Some commonly recommended nutraceuticals are:
1. **Omega-3 fatty acids**: Found in fish oil, these can help reduce blood pressure and inflammation.
2. **Coenzyme Q10 (CoQ10)**: May improve energy production in cells and has antioxidant properties.
3. **Magnesium**: Important for blood pressure regulation and can be taken as a supplement.
4. **Garlic**: Known for its potential blood pressure-lowering effects.
5. **Potassium**: Available as a supplement or in high-potassium foods (unless restricted due to kidney function).
Always consult healthcare providers before beginning any new supplement, as interactions with medications or existing conditions need to be considered. - Peptides
- Renal hypertension, also known as renovascular hypertension, occurs due to the narrowing of arteries that supply blood to the kidneys. Peptides, such as angiotensin II, play a crucial role in this condition. Angiotensin II is part of the renin-angiotensin-aldosterone system (RAAS) and contributes to vasoconstriction and sodium retention, which increase blood pressure. Nanotechnology applications in renal hypertension are still largely in the research phase but hold potential for targeted drug delivery systems and improved diagnostic methods.