[PP.09.02] ACCESSORY RENAL ARTERIES IN RESISTANT HYPERTENSION. (September 2016)

• Record Type: Journal Article
• Authors: Le Jeune, S.; Radhouani, I.; Sosner, P.; Perez, L.; Barber-Chamoux, N.; Boudghene-Stambouli, F.; Lopez-Sublet, M.; Brucker, M.; Delsart, P.; Baguet, S.; Dourmap, C.; Mourad, J.-J.
• Is Part Of: Journal of hypertension. Volume 34:(2016) Supplement 2
• Publication Date: 2016-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000491790.76283.27
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Refractory hypertension (RHT) is a major health care concern affecting 20 to 30% of hypertensive patients and increasing cardiovascular risk. Recent renal denervation trials suggest a high prevalence of accessory renal arteries (ARA) in RHT. Previous publications report a putative role of ARA in triggering hypertension through renin secretion in underperfused renal segments. Our objective was to compare the prevalence of ARA in RHT vs non-refractory hypertension (NRHT). Design and method: 86 essential hypertensive patients who benefited from an abdominal CT-scan or MRI during their initial work-up were retrospectively recruited in 6 french hypertension centers. At the end of a minimal 6 months of follow up, patients were classified between RHT or NRHT. RHT was defined as blood pressure that remains above goal in spite of 3 antihypertensive agents at optimal dose including a diuretic, or controlled by more than 3 medications (Calhoun, 2008). Other patients were classified as NRHT. Blinded independant central review of all radiologic renal artery charts was performed. Results: Baseline characteristics were: age 50 ± 15 years, 62% males, BP 145 ± 23 / 87 ± 13 mmHg. 53 (62%) patients had RHT and 25 (29%) had at least one ARA. Prevalence of ARA was comparable between RHT (25%) and NRHT patients (33%, p = 0, 62), but there were significantly more ARA per patient in NRHT (2 ± 0, 9) vs RHT (1, 3 ± 0, 5, p = 0, 03). ARA were similar in diameter or length between the 2 groups. Patients with ARA had a significative increase in renin plasma levels at baseline (51, 6 ± 49, 3 mUI/l) versus patients without ARA (20, 3 ± 25, 1 mUI/l, p = 9x10-3), but this did not translate into a worse blood pressure control or a raise in medication number, especially in renin angiotensin system inhibitors at the end of follow up. Conclusions: In this retrospective series of 86 essential hypertensive patients, we found no difference in the prevalence of ARA in RHT and NRHT, but NRHT patients had significantly more ARA per patients than RHT patients. This study confirms elevated renin plasma levels at baseline in hypertensive patients with ARA, but limits its clinical relevance in terms of blood pressure control.