A Case of Renovascular Hypertension Treated with Percutaneous Transluminal Angioplasty

A case of renovascular hypertension was treated with percutaneous transluminal angioplasty. A 45-year-old man was found to have hypertension 7 years prior to admission and since that time was given several antihypertensive drugs. He was referred to our hospital because adequate control of blood pressure was not achieved. At admission, blood pressure was 190/134 mmHg and optic fundi, Keith-Wagener II a. Renal functions including creatinine clearance were normal. Isotopic renogram demonstrated a decreased uptake and a delayed excretion of¹³¹I labelled Hippuran from the right kidney. Renogram showed a delayed accumulation phase and a retentive terminal phase of the right kidney. Abdominal aortography showed a 90% stenosis at the midportion of the right renal artery. Plasma renin activity (PRA) of peripheral blood was as high as 9.8 ng/ml/hr in the supine position under 10 g of daily salt intake and PRA ratio (affected/unaffected renal vein) was 2.0. A diagnosis of renovascular hypertension was made and percutaneous transluminal angioplasty (P.T.A) was performed for the right renal artery stenosis. Repeat abdominal artography demonstrated patency of angioplasty site after P. T. A. Blood pressure was 148/110 mmHg at 30 min, after P. T. A., and gradually decreased to 126/96 mmHg at 24 days after P. T. A. Responses of blood pressure and PRA to angiotensin II analogue (1-sar, 8-ile, angiotension II; 600 ng/kg/min) infusion and a single oral administration of angiotensin converting enzyme inhibitor (SQ 14,225; 25 mg) were compared before and 2 weeks after P.T.A. Mean blood pressure (MBP) was unchanged to angiotensin II analogue infusion before P. T. A., whereas pressure reponse (15% increment in MBP from the control level) was observed after P. T. A. Ten %reduction in MBP and reactive hyperreninemia (9.8 → 105 ng/ml/hr) were observed at 1 hr after the single administration of SQ 14,225 before P.T.A., whereas both changes were not observed after P. T. A. These findings suggest that activity of the renin-angiotensin system was ameliorated after P. T. A.