How to Manage Renal Hypertension Effectively

Understanding Renal Hypertension and Its Management

Did you know that your kidneys could be the hidden trigger behind your stubborn high blood pressure? Renovascular hypertension, a secondary yet treatable cause, affects up to 10% of all hypertension cases worldwide. With over 1 in 3 adults battling high blood pressure (WHO), early detection of kidney-related causes can be life-saving, reducing the risk of stroke, heart attack and kidney failure.

So, let us keep reading to know in detail how you can manage renovascular hypertension.

How to Cure or Manage Renal Hypertension?

The management of renovascular hypertension depends on the underlying cause. The foundation of treatment for all cases is intensive medical therapy to control blood pressure and protect the heart and kidneys. Revascularization procedures may be considered in specific circumstances, particularly for fibromuscular dysplasia or for complicated cases of atherosclerotic disease. 

1. Antihypertensive Medications : Antihypertensive medications help manage blood pressure and are considered the first line of treatment. Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE-Is) form the cornerstone of therapy for renovascular hypertension. However, these are used with caution in patients with bilateral renal artery stenosis or a solitary functioning kidney.
2. Statins and Calcium : Statins and calcium channel blockers are also effective in managing the symptoms of renovascular hypertension. Statins improve endothelial function and reduce cardiovascular risks, while calcium channel blockers assist in lowering blood pressure by relaxing blood vessels.
3. Renal Artery Angioplasty : The role of revascularization (angioplasty/stenting) has changed. For fibromuscular dysplasia, it is often a first-line treatment. However, for atherosclerotic renal artery stenosis, stenting is no longer routinely recommended. It is typically considered only in specific situations, such as recurrent 'flash' pulmonary edema with bilateral disease, rapidly declining kidney function, or hypertension that remains uncontrolled despite optimal medical therapy.
4. Surgery : In certain cases, surgical procedures such as renal revascularisation may be required to treat renovascular hypertension. During this surgery, a synthetic tube or a healthy blood vessel from another part of the body is used to connect the aorta to the kidney, creating a new pathway for continuous blood flow.

What is renovascular hypertension?

Renovascular hypertension, also referred to as renal hypertension, occurs when the arteries that carry blood to the kidneys become narrowed. This reduced blood supply activates the Renin-Angiotensin-Aldosterone System (RAAS), which regulates blood pressure. Overactivity of this system results in hypertension.

When to Visit a Healthcare Provider for Renovascular Hypertension?

Renovascular hypertension often has no noticeable symptoms. However, you should consult a healthcare provider if you experience any of the following:

• A sudden spike in blood pressure that does not reduce despite taking medications
• The onset of high blood pressure before the age of 30 or after 50
• Sudden occurrence of kidney failure
• Multiple hypertensive crisis episodes
• Unexpected episodes of pulmonary oedema
• Chest pain without significant plaque buildup in the coronary arteries

How do doctors diagnose renovascular hypertension?

Doctors begin diagnosis by evaluating the patient’s symptoms and medical history. They may recommend:

• Blood tests to assess kidney function and hormone levels
• Urine tests to check for protein or blood in the urine
• Imaging studies, such as a kidney ultrasound, Doppler studies, CT angiography, or MR angiography, to detect narrowing of the renal arteries

These methods help identify the underlying issue and plan appropriate treatment.

What are the complications of renovascular hypertension?

If left untreated, renovascular hypertension can lead to several serious complications, including:

• Hypertensive heart disease resulting from prolonged strain on the heart
• Kidney damage or failure due to chronic reduced blood flow
• Retinal damage, which may impair vision

Early diagnosis and proper treatment significantly reduce the risk of complications. It is crucial to follow the instructions given by the medical professional accurately. Taking the medications as prescribed, following a diet that is hypertension-friendly and exercising regularly could be beneficial towards life living.