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Comment
. 2022 Sep 6;11(17):e025901.
doi: 10.1161/JAHA.122.025901. Epub 2022 Aug 17.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour Blood Pressure Profiles

Keisuke Narita  1 , Satoshi Hoshide  1 , Kazuomi Kario  1
Affiliations
Comment

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour Blood Pressure Profiles

Keisuke Narita et al. J Am Heart Assoc. .
No abstract available

Keywords: atherosclerotic renovascular disease; cardiovascular disease prevention; management on hypertension; treatment resistant hypertension.

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Figures

Figure 1
Figure 1. Mechanisms and management of renovascular hypertension.
Renal artery stenosis leads to renal hypoperfusion, which induces excessive activation of the RAAS and the sympathetic nervous systems, as well as fluid retention caused by the decrease in pressure natriuresis. These abnormalities cause elevation of BP levels and flash pulmonary edema. Based on the mechanisms of renovascular hypertension, we speculated that an increase in nighttime BP levels and abnormal nocturnal BP dipping may occur in patients with resistant hypertension due to renovascular disease. Nighttime BP is an important target to prevent CVD events especially in resistant hypertension. In the management of renovascular hypertension, interventional renal angioplasty including PTRA should be considered in patients with poor BP control despite adequate use of multiple antihypertensive medications. *Contraindicated in bilateral stenosis and taking care of renal dysfunction. ACEI indicates angiotensin‐converting enzyme inhibitors; ARB, angiotensin receptor antagonist; BMI, body mass index; BP, blood pressure; CHF, congestive heart failure; CKD, chronic kidney disease; CVD, cardiovascular disease; eGFR; estimated glomerular filtration ratio; HT, hypertension; PTRA, percutaneous transluminal angioplasty; and RAAS, renin angiotensin aldosterone system.
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