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What is Hypertension?

A condition in which the force of the blood against the artery walls is too high.Usually hypertension is defined as blood pressure above 140/90. Chronichypertension damages blood vessels in various organs like heart, kidney andbrain. And it leads to a decreased function of major organs over a period oftime.And Hypertension (high blood pressure) is a leading cause of kidney diseaseand kidney failure (end-stage renal disease). Hypertension can damage theblood vessels and filters in the kidney. So it affects removal of waste from thebody. When an individual is diagnosed with end-stage renal disease, dialysis orkidney transplantation are usually required.

What is Resistant Hypertension?

Resistant hypertension is high blood pressure that can’t be controlled despitemedications. Hypertension is considered resistant when all of the followingconditions are met:

 Three different blood pressure medications are being taken at theirmaximum tolerated doses.

 A diuretic is one of the blood pressure medications (removes fluid andsalt from the body).

 Blood pressure remains higher than your target—(usually 130/80 mmHg,but individual goals should be discussed with your doctor)

 Resistant hypertension occurs when hypertension requires four or moremedications to control.

Resistant hypertension increases the risk of heart attack, stroke, and kidneyfailure significantly.Symptoms of Resistant Hypertension:

Hypertension can exist without any symptoms. The best way to know if youhave high blood pressure is to have it checked by a health care provider.Symptoms can occur when blood pressure first starts to rise or during ahypertensive crisis, when levels are extremely high. These symptoms may include

 Severe headaches

 Severe anxiety

 Shortness of breath

 Chest pain

 Nosebleeds

Causes of Resistant Hypertension:

 Physical inactivity

 Obesity

 A diet high in salt

 Heavy alcohol intake

 Painkiller medications, especially NSAIDs (non-steroidal anti-

inflammatory drugs) like ibuprofen and naproxen

 Nasal decongestants

 Oral contraceptives (birth control pills)

 Ginseng, licorice or other herbal products

 Sleep apnea

 Renal (kidney) artery stenosis

 Coarctation of the aorta

 Kidney failure

 Chronic kidney disease

 Pheochromocytoma, an adrenal gland tumour, aortic narrowing, and

Cushing syndrome, an overproduction of some steroid hormones, are

less common causes.

Who is at risk for developing resistant hypertension?

You’re more likely to have resistant hypertension if you:

 Are of older age.

 Have chronic kidney disease.

 Have diabetes.

 Having obesity

 Lack of physical activity or exercise

 Smoking and alcohol consumption

Diagnosis of resistant hypertension?

To diagnose resistant hypertension, a doctor will:

 perform a physical exam

 take a full history

 measure a person’s blood pressure

 test for secondary conditions

 electrocardiogram (EKG)

 chest X-ray

 echocardiogram

 urinalysis

 fundoscopic eye exam to check for damaged blood vessels in the eye

Treatment for Resistant Hypertension

Our specialized doctors take the time to understand why you have high blood

pressure and how it affects your health. We may discover that established

treatment approaches can effectively treat you.

Medication

Depending on the results of diagnostic tests, medication will be reassessed and

surgery may be considered following an evaluation for resistant hypertension.

Lifestyle Changes

Changes may be suggested to reduce overall hypertension. This includes

maintaining a low sodium diet, keeping a home blood pressure log, attending

educational workshops, reducing or managing stress, limiting alcohol

consumption, and quitting smoking.

Renal Denervation

Renal denervation is a new form of treatment for resistant hypertension that

targets the blood pressure-regulating nerves near the kidneys. Surgeons or

intervention radiologist will attempt to relieve hypertension by severing these

renal artery nerves, which results in lowering blood pressure.

What is Renovascular Hypertension?

Renovascular hypertension is a leading cause of secondary hypertension and

frequently leads to resistant hypertension. It is defined as systemic

hypertension caused by a compromised blood supply to the kidneys,

usually due to an occlusive lesion in the main renal artery. Renovascular

hypertension is high blood pressure (greater than 140/80 mmHg) caused by

renal artery disease. This condition is also called renal artery stenosis.

Renovascular hypertension patients may have a history of very high blood

pressure that is difficult to control with medications.

Renovascular hypertension symptoms include:

 High blood pressure at a young age

 High blood pressure that suddenly worsens to control

 Kidneys that are not working well

 Narrowing of other arteries in the body, including those in the legs,

brain, eyes, and elsewhere

 Sudden build-up of fluid in the air sacs of the lungs (pulmonary edema)

 Bad headache

 Nausea or vomiting

 Confusion

 Changes in vision

 Nosebleeds

Causes:

Renal artery stenosis is a narrowing or blockage of the arteries that supply the

kidneys with blood.

The most common cause of renal artery stenosis is an artery blockage caused

by high cholesterol. This issue arises when a sticky, fatty substance known as

plaque accumulates on the inner lining of the arteries, causing a condition

known as atherosclerosis.

Less blood flows to the kidneys when the arteries that carry blood to them

become narrowed. The kidneys mistakenly respond as if your blood pressure is

low. As a result, they release hormones that instruct the body to store more

salt and water. This causes your blood pressure to rise.

Risk factors for atherosclerosis:

 High blood pressure

 Diabetes

 Smoking

 High cholesterol levels

 Heavy alcohol consumption

 Cocaine addiction

 Old age

Another cause of renal artery stenosis is fibro muscular dysplasia. It is most

common in women under the age of 50. It tends to run in families. The

condition is caused by abnormal cell growth in the walls of the arteries that

lead to the kidneys. This causes narrowing or blockage of the arteries.

How is renal hypertension diagnosed?

 Blood Tests

 Angiotensin converting enzyme (ACE) inhibition renography

 Duplex ultrasound

 Computerized tomographic angiography, or CTA

 Magnetic resonance angiogram, or MRA

 contrast angiography

Possible Complications:

 Aortic aneurysm

 The heart attack

 Heart failure

 Chronic kidney disease

 Stroke

 Vision issues

 Poor blood supply to the legs

Renovascular Hypertension Treatment:

Renovascular disease can be fatal if not treated. Fortunately, there is

treatment available. The treatment's goal is to keep blood pressure under

control and prevent kidney failure.

The goal is to lower your blood pressure. In renal vascular hypertension, two

specific types of medications may work better to control your blood pressure:

 Angiotensin-converting enzyme (ACE) inhibitors.

 Angiotensin receptor blockers (ARBs).

Lifestyle Changes

If you smoke, your health care team will advise you to quit. You will also be

asked to change your diet and increase your physical activity to improve your

heart health. Maintaining healthy lifestyle habits has been proven to help.

Medicine

Renal hypertension treatment for high blood pressure often begins with lifestyle

changes. Aspirin, cholesterol-lowering medications, and medications for other

conditions may also be included. High blood pressure medications are very

effective at controlling blood pressure, but the disease can progress to block

arteries. Your medical team will aim to prevent the loss of kidney tissue and

progressive kidney failure. This is more difficult if renal artery stenosis hurts

both kidneys.

Surgical Procedures

If you require additional treatment, your doctor may advise you to undergo

surgery. Endovascular procedures are used to clear obstructions in the kidney

arteries. These treatments have the potential to improve blood flow to your

kidneys. When blood flow returns, your kidneys can function and high blood

pressure may get lower.

Balloon angioplasty

Balloon angioplasty is a common treatment for renal artery blockages. It is

performed inside the blood vessel using a tiny balloon attached to the end of a

small, flexible tube known as a catheter. A renal artery stent may be placed in

patients with atherosclerotic disease. According to research, this helps for a

while, but more treatment may be required in the long run.

Surgical revascularization

Surgical revascularization (renewal of blood flow) may be required. It is used

when medicine, balloon angioplasty, and stent placement are insufficient.

When kidney failure is discovered, this is used. Many surgical procedures are

available to restore blood flow. Aortorenal bypass grafts, for example, and

extra anatomic bypass procedures.

Some people may require a more complex procedure such as bench surgery.

And this includes a kidney transplant as well as renal vessel reconstruction.

Our doctor DR PRANITH RAM, Best Nephrologist in Hyderabad regularly

evaluates for challenging cases of resistant hypertension & Renovascular

Hypertension. Our team of Renal Hypertension Treatment Doctors has the

expertise to determine whether lifestyle changes and medications can help

protect your health. We also explore new options for treating hypertension

that has not responded to existing treatments.