Emerging approaches in secondary hypertension due to renal artery stenosis: evaluation and treatment - systematic review
DOI:
https://doi.org/10.18203/2349-3933.ijam20240952Keywords:
Secondary hypertension, Renal artery stenosis, TreatmentAbstract
Hypertension, a global health concern, affects a staggering 1.28 billion people worldwide, as stated by the World Health Organization (WHO) however renal artery stenosis (RAS), a common cause of secondary hypertension, is characterized by the narrowing of renal arteries, leading to physiological changes such as arterial stiffening and elevated blood pressure. The major causes of RAS include atherosclerosis and fibromuscular dysplasia. Diagnosis involves clinical suspicion and imaging studies such as Doppler ultrasonography and angiography. Treatment strategies encompass lifestyle modifications, pharmacotherapy, interventional procedures like angioplasty with stenting, and emerging options such as renal denervation and gene therapy. Our aim is to provide a comprehensive examination of the pathophysiology, prevalence, risk factors, causes, diagnosis, and treatment modalities through a systematic search gathering qualitative and quantitative data. We address the challenges in diagnosis and treatment, emphasizing the need for tailored approaches considering patient-specific factors. We will review emerging approaches in evaluating and treating secondary hypertension due to RAS.
References
Bokhari MR, Bokhari SRA. Renal artery stenosis. StatPearls - NCBI Bookshelf. 2023.
Balk EM, Raman G, Adam GP, Halladay CW, Langberg VN, Azodo IA, et al. Renal Artery Stenosis Management Strategies: An Updated Comparative Effectiveness Review. Comparative Effectiveness Reviews, No. 179. Rockville (MD): Agency for Healthcare Research and Quality (US). 2016.
Mousa AY, Bates MC, Broce M, Bozzay J, Morcos R, AbuRahma AF. Issues related to renal artery angioplasty and stenting. Vascular. 2017;25(6):618-28.
Courand PY, Dinic M, Lorthioir A, Bobrie G, Grataloup C, Denarié N, et al. Resistant Hypertension and Atherosclerotic Renal Artery Stenosis: Effects of Angioplasty on Ambulatory Blood Pressure. A Retrospective Uncontrolled Single-Center Study. Hypertension. 2019;74(6):1516-23.
ASTRAL Investigators; Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, et al, Nicholson A, Scoble J. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med. 2009;361(20):1953-62.
Mohan IV, Bourke V. The management of renal artery stenosis: an alternative interpretation of ASTRAL and CORAL. Eur J Vasc Endovasc Surg. 2015;49(4):465-73.
National Kidney Foundation. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptors. 2023. Available: https://www.kidney.org/ atoz/content/angiotensin-converting-enzyme-ace-inhibitors-angiotensin-receptor-blockers-arbs. Accessed on 12 February 2024.
Marcusohn E, Tobe SW, Dueck A, Madan M. Renal denervation for uncontrolled hypertension. CMAJ. 2023;195(43):E1475-80.
Soares S, Souza LC, Cronin MTD, Waaga-Gasser AM, Grossi MF, Franco GR, et al. Biomarkers and in vitro strategies for nephrotoxicity and renal disease assessment. J Nephrol Renal Dis. 2020;5(1).
Safian RD. Renal artery stenosis. Progress Cardiovasc Dis. 2021;65:60-70.
Rao PS. A radiological study of renal artery pathologies by renal Doppler, CT renal angiogram and non-contrast resonance renal angiogram. J Cont Med A Dent. 2020;8(2):30-4.
Beylerli O, Shi H, Begliarzade S, Shumadalova A, Ilyasova T, Sufianov A. MiRNAs as new potential biomarkers and therapeutic targets in brain metastasis. Noncoding RNA Res. 2024;9(3):678-86.
Musayeva TM. The impact of cardiac rehabilitation on endothelial dysfunction in coronary artery disease. Rüblük Elmi-Praktik J. 2023;3:89.
Dobrek L. An outline of renal artery stenosis pathophysiology—a narrative review. Life. 2021;11(3):208.
Sequeira-Lopez MLS, Gomez RA. Renin cells, the kidney, and hypertension. Circulat Res. 2021;128(7):887-907.
Saleem M, Saavedra-Sánchez L, Barturen-Larrea P, Gomez JA. The Transcription Factor Sox6 Controls Renin Expression during Renal Artery Stenosis. Kidney360. 2021;2(5):842-56.
Martyniak A, Tomasik PJ. A new perspective on the renin-angiotensin system. Diagnostics. 2022;13(1):16.
Gelen V, Kükürt A, Şengül E. Role of the renin-angiotensin-aldosterone system in various disease processes: An overview. Renin-Angiotensin Aldosterone System. 2021;55.
Alex J, Rajpurohit D, Zughaib M. Renovascular Hypertension with Progressive Atherosclerotic Renal Artery Stenosis in an Elderly Patient with Known Fibromuscular Dysplasia: A Case Report. Am J Case Rep. 2023;24:e939881.
Silva IMS, Assersen KB, Willadsen NN, Jepsen J, Artuc M, Steckelings UM. The role of the renin-angiotensin system in skin physiology and pathophysiology. Exp Dermatol. 2020;29(9):891-901.
Bonetti J, Corti A, Lerouge L, Pompella A, Gaucher C. Phenotypic Modulation of Macrophages and Vascular Smooth Muscle Cells in Atherosclerosis-Nitro-Redox Interconnections. Antioxidants (Basel). 2021;10(4):516.
Manaktala R, Tafur-Soto JD, White CJ. Renal Artery Stenosis in the Patient with Hypertension: Prevalence, Impact and Management. Integr Blood Press Control. 2020;13:71-82.
Xue B, Zhang Y, Johnson AK. Interactions of the Brain Renin-Angiotensin-System (RAS) and Inflammation in the Sensitization of Hypertension. Front Neurosci. 2020;14:650.
Huang Z, Cao J, Yao Y, Jin X, Luo Z, Xue Y, et al. The effect of RAS blockers on the clinical characteristics of COVID-19 patients with hypertension. Ann Transl Med. 2020;8(7):430.
Khurana V, Goswami B. Angiotensin converting enzyme (ACE). Clinica Chimica Acta. 2022;524:113-22.
Gallo G, Volpe M, Rubattu S. Angiotensin Receptor Blockers in the Management of Hypertension: A Real-World Perspective and Current Recommendations. Vasc Health Risk Manag. 2022;18:507-15.
Chan HL, Papazoglou DD, Jungi S, Weiss S, Becker D, Kotelis D, et al. Fenestrated Physician-Modified Endografts for Preservation of Main and Accessory Renal Arteries in Juxtarenal Aortic Aneurysms. J Clin Med. 2023;12(14):4708.
Vrablik M, Corsini A, Tůmová E. Beta-blockers for Atherosclerosis Prevention: a Missed Opportunity? Curr Atheroscler Rep. 2022;24(3):161-9.
Iwashima Y, Ishimitsu T. How should we define appropriate patients for percutaneous transluminal renal angioplasty treatment? Hypertens Res. 2020;43(10):1015-27.
Dewi IP, Mardiana N. Renal Artery Stenosis: The Challenging in Diagnosis and Therapy. In IOP Conference Series: Earth and Environmental Sci. 2020;441(1):012180).
Wongpraparut N, Chaipruckmalakarn T, Tongdee T, Jaspttananon A, Vongwiwatana A, Premasathian N, et al. Long-term outcome of percutaneous transluminal renal angioplasty (PTRA) versus PTRA with stenting (PTRAS) in transplant renal artery stenosis. BMC Cardiovasc Disord. 2021;21(1):212.
Farhat H, Kuzemczak M, Durel N, Caillot N, Pawłowski T, Lipiecki J. Rotational Atherectomy Versus Intravascular Lithotripsy for Calcified In-Stent Restenosis: A Single-Center Study With 1-Year Follow-Up. Am J Cardiol. 2023;205:413-9.
