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Triantafyllou G, Paschopoulos I, Węgiel A, Olewnik Ł, Tsakotos G, Zielinska N, Piagkou M. The accessory renal arteries: A systematic review with meta-analysis. Clin Anat 2024. [PMID: 39648312 DOI: 10.1002/ca.24255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 11/01/2024] [Accepted: 11/30/2024] [Indexed: 12/10/2024]
Abstract
The accessory renal arteries (ARAs) are a well-described variant of the renal vasculature with clinical implications for radiologists, surgeons, and clinicians. The aim of the present systematic review with meta-analysis was to estimate the pooled prevalence of ARAs, including their variant number, origin, and termination, and to highlight symmetrical and asymmetrical morphological patterns. The systematic review used four online databases in accordance with PRISMA 2020 and Evidence-based Anatomy Workgroup guidelines. R programming software was used for the statistical meta-analysis. A total of 111 studies were considered eligible for our initial aim. The typical renal artery (RA) anatomy (a single bilateral vessel) was identified in 78.92%; the overall ARA prevalence was estimated at a pooled prevalence of 21.10%. The estimated pooled prevalence of one, two, three, and four ARAs were 18.67%, 1.80%, 0.01%, and <0.01%. The ARAs have been the subject of extensive research owing to their clinical importance, including in kidney transplantation surgery and resistant hypertension therapy. Knowledge of the typical and variant anatomy of RAs is essential for anatomists, radiologists, surgeons, and clinicians in order to avoid misunderstanding, complications, and iatrogenic injury.
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Affiliation(s)
- George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Paschopoulos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrzej Węgiel
- Department of Clinical Anatomy, Masovian Academy in Płock, Płock, Poland
| | - Łukasz Olewnik
- Department of Clinical Anatomy, Masovian Academy in Płock, Płock, Poland
| | - George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicol Zielinska
- Department of Clinical Anatomy, Masovian Academy in Płock, Płock, Poland
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Mohammed S, AbdAlla E, Elhag A, El-Mardi A. The prevalence of accessory renal arteries in sudanese population in Khartoum State: a cross-sectional CT study from 2017 to 2020. BMC Nephrol 2024; 25:135. [PMID: 38622526 PMCID: PMC11017523 DOI: 10.1186/s12882-024-03573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Renal artery variations are clinically significant due to their implications for surgical procedures and renal function. However, data on these variations in Sudanese populations are limited. This study aimed to determine the prevalence and characteristics of renal artery variations in a Sudanese population. METHODS A cross-sectional retrospective study was conducted in Khartoum state from October 2017 to October 2020. A total of 400 Sudanese participants who underwent abdominal CT scans were included. Data on demographic characteristics, kidney measurements, and renal vasculature were collected and analyzed using descriptive statistics and inferential tests. RESULTS The mean age of participants was 46.7 ± 18 years, with a nearly equal gender distribution. Overall, renal artery variations were present in 11% of participants, with accessory renal arteries observed in 6% of the study population. Among those with accessory vessels, 50% were on the right side, 29.2% on the left, and 20.8% bilateral, distributed across hilar 29.2%, lower polar 29.2%, and upper polar 41.7% regions. No significant associations were found between accessory renal arteries and age or gender (p-value > 0.05). However, participants with accessory renal arteries exhibited significantly narrower width 5.0 ± 1.4 than those with no with accessory renal arteries 5.8 ± 1.1 (p-value 0.002) Early dividing renal arteries were found in 5% of participants, with nearly half being bilateral. No significant associations were found between the presence of early dividing renal arteries and demographic or renal measurements (p-value > 0.05). CONCLUSION This study provides valuable insights into the prevalence and characteristics of renal artery variations in a Sudanese population. The findings contribute to our understanding of renal anatomy in this demographic and can inform clinical practice and surgical planning, particularly in renal transplantation and other renal procedures.
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Affiliation(s)
- Safaa Mohammed
- Nursing Department, Faculty of Medical Sciences and Nursing, Alrayan Colleges, Almadina, Saudi Arabia
| | - Eltayeb AbdAlla
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
| | - Amal Elhag
- Assistant Professor of Human Anatomy, Faculty of Medicine and Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
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Wu F, Yuan X, Sun K, Zhang Y, Zhu L, Bai C, Cheng Y, Lu Y, Jiang Y, Song W. Effect of Accessory Renal Arteries on Essential Hypertension and Related Mechanisms. J Am Heart Assoc 2024; 13:e030427. [PMID: 38348775 PMCID: PMC11010091 DOI: 10.1161/jaha.123.030427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND This case-control study aimed to determine whether there were differences between patients with essential hypertension with accessory renal arteries (ARAs) and those without ARAs. METHODS AND RESULTS The enrolled patients with essential hypertension were divided into the ARA group (n=200) and control group without ARAs (n=238). After propensity matching, 394 patients (197 in each of the 2 groups), were included. The 24-hour BP (4.33/2.43 mm Hg) and daytime BP (4.48/2.61 mm Hg) of patients in the ARA group were significantly higher than those of the control group (P<0.05). The flow-mediated dilation was lower in the ARA group (5.98±2.70 versus 5.18±2.66; P<0.05). In correlation analysis, the horizontal plasma aldosterone concentration had the highest correlation with 24-hour, daytime, and nighttime systolic BP (r=0.263, 0.247, and 0.243, respectively; P<0.05) and diastolic BP (r=0.325, 0.298, and 0.317, respectively; P<0.05). As for multivariate regression analysis, plasma aldosterone concentration was a significant risk factor for elevated 24-hour, daytime, and nighttime systolic BP (β=0.249 [95% CI, 0.150-0.349], 0.228 [95% CI, 0.128-0.329], and 0.282 [95% CI, 0.187-0.377], respectively; P<0.05) and elevated diastolic BP (β=0.289 [95% CI, 0.192-0.385], 0.256 [95% CI, 0.158-0.353], and 0.335 [95% CI, 0.243-0.427], respectively; P<0.05). Direct renin concentration was also a risk factor for 24-hour and daytime BPs, whereas heart rate was a risk factor correlated with 24-hour, daytime, and nighttime diastolic BP (all P<0.05). For the mixed-effects model for repeated measures, the results were similar to results of the multivariate regression analysis (all P<0.05). CONCLUSIONS ARAs could contribute a higher BP of patients with essential hypertension and might promote the development of essential hypertension. The mechanism might be related to overactivation of the renin-angiotensin-aldosterone system and sympathetic nervous system.
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Affiliation(s)
- Fengyuan Wu
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Xiaoyang Yuan
- Department of Clinical LaboratoryFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Kaiwen Sun
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Ying Zhang
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Lianxin Zhu
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Cuiping Bai
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Yunpeng Cheng
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Yan Lu
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Yinong Jiang
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
| | - Wei Song
- Department of CardiologyFirst Affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-63860.186.92a54.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023; 11:1506-1512. [PMID: 36926389 PMCID: PMC10011986 DOI: 10.12998/wjcc.v11.i7.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/11/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia. Although accessory renal arteries are frequent, to date, only six cases of secondary hypertension determined by their existence have been reported. CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy. Despite normal renal arteries, the computed tomography angiography revealed an inferior polar artery with 50% stenosis of its diameter. Conservative treatment with amlodipine, indapamide and perindopril was adopted, leading to blood pressure control within one month. CONCLUSION To the best of our knowledge, there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension, but the seven similar cases already described, along with the current case, could reinforce the necessity of more studies concerning this subject.
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Affiliation(s)
- Amalia Calinoiu
- Department of Internal Medicine, Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital, Bucuresti 011356, București, Romania
| | - Elena-Cristina Guluta
- Department of Gastroenterology, Bucharest University Emergency Hospital, Bucharest 050098, Romania
| | - Adina Rusu
- Department of Internal Medicine, Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital, Bucuresti 011356, București, Romania
| | - Alexandra Minca
- Department of Internal Medicine Clinic, Bucharest University Emergency Hospital, Bucharest 050098, Romania
| | - Dragos Minca
- Department of Rheumatology Clinic, Center of Rheumatic Disease "Dr. Ion Stoia", Bucharest 030167, Romania
| | - Luminita Tomescu
- Department of Radiology Clinic, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Valeriu Gheorghita
- Department of Infectious Disease Clinic, Prof Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Dana Galieta Minca
- Department of Public Health and Management, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Lucian Negreanu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-3343.186.9f95e.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: 10.12998/wjcc.v11.i7.1506
bcc:009247.186-127021.186.264be.19420.2@bxss.me] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Calinoiu A, Guluta EC, Rusu A, Minca A, Minca D, Tomescu L, Gheorghita V, Minca DG, Negreanu L. Accessory renal arteries - a source of hypertension: A case report. World J Clin Cases 2023. [DOI: ./10.12998/wjcc.v11.i7.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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Maisons V, Le Jeune S, Barber-Chamoux N, Boudghene-Stambouli F, Brucker M, Delsart P, Lopez-Sublet M, Perez L, Radhouani I, Sosner P, Sautenet B. Relationship between accessory renal arteries and resistant hypertension: A cohort study. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:18-23. [PMID: 37120265 DOI: 10.1016/j.jdmv.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/20/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Resistant hypertension (RHT) is a major health care concern affecting 20 to 30% of hypertensive patients and increasing cardiovascular risk. Recent renal denervation trials have suggested a high prevalence of accessory renal arteries (ARA) in RHT. Our objective was to compare the prevalence of ARA in RHT vs. non-resistant hypertension (NRHT). METHODS Eighty-six patients with essential hypertension who benefited from an abdominal CT-scan or MRI during their initial workup were retrospectively recruited in 6 French ESH (European Society of Hypertension) centers. At the end of a follow-up period of at least 6 months, patients were classified between RHT or NRHT. RHT was defined as uncontrolled blood pressure despite the optimal doses of three antihypertensive agents of which one is a diuretic or similar, or controlled by ≥ 4 medications. Blinded independent central review of all radiologic renal artery charts was performed. RESULTS Baseline characteristics were: age 50±15 years, 62% males, BP 145±22/87±13mmHg. Fifty-three (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 more ARA per patient in NRHT (2±0.9) vs. RHT (1.3±0.5, P=0.05), and renin levels were higher in ARA group (51.6±41.7 mUI/L vs. 20.4±25.4 mUI/L, P=0.001). ARA were similar in diameter or length between the 2 groups. CONCLUSIONS In this retrospective series of 86 essential hypertension patients, we found no difference in the prevalence of ARA in RHT and NRHT. More comprehensive studies are needed to answer this question.
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Affiliation(s)
- Valentin Maisons
- Club des jeunes hypertensiologues, France; Service de néphrologie, CHU de Tours, Tours, France; Inserm U1246 SPHERE, université de Nantes, université de Tours, Tours, France.
| | - Sylvain Le Jeune
- Club des jeunes hypertensiologues, France; Service de médecine interne et vasculaire, CHU d'Avicenne, AP-HP, Bobigny, France.
| | - Nicolas Barber-Chamoux
- Club des jeunes hypertensiologues, France; Service de cardiologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Fanny Boudghene-Stambouli
- Club des jeunes hypertensiologues, France; Service de cardiologie, polyclinique Saint-Laurent, Rennes, France.
| | - Marie Brucker
- Club des jeunes hypertensiologues, France; Service de néphrologie, centre hospitalier de Valence, Valence, France.
| | - Pascal Delsart
- Club des jeunes hypertensiologues, France; Service de médecine vasculaire et HTA, CHU de Lille, Lille, France.
| | - Marilucy Lopez-Sublet
- Club des jeunes hypertensiologues, France; Service de médecine interne et vasculaire, CHU d'Avicenne, AP-HP, Bobigny, France; Inserm U942 MASCOT, université Paris Nord, Paris 13, France; FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
| | - Laurence Perez
- Club des jeunes hypertensiologues, France; Service de cardiologie, clinique d'Occitanie, Muret, France.
| | | | - Philippe Sosner
- Club des jeunes hypertensiologues, France; Mon Stade, maison sport-santé, Paris, France.
| | - Bénédicte Sautenet
- Club des jeunes hypertensiologues, France; Service de néphrologie, CHU de Tours, Tours, France; Inserm U1246 SPHERE, université de Nantes, université de Tours, Tours, France; FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
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Bhalla V, Textor SC, Beckman JA, Casanegra AI, Cooper CJ, Kim ESH, Luther JM, Misra S, Oderich GS. Revascularization for Renovascular Disease: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e128-e143. [PMID: 35708012 PMCID: PMC11731842 DOI: 10.1161/hyp.0000000000000217] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renovascular disease is a major causal factor for secondary hypertension and renal ischemic disease. However, several prospective, randomized trials for atherosclerotic disease failed to demonstrate that renal revascularization is more effective than medical therapy for most patients. These results have greatly reduced the generalized diagnostic workup and use of renal revascularization. Most guidelines and review articles emphasize the limited average improvement and fail to identify those clinical populations that do benefit from revascularization. On the basis of the clinical experience of hypertension centers, specialists have continued selective revascularization, albeit without a summary statement by a major, multidisciplinary, national organization that identifies specific populations that may benefit. In this scientific statement for health care professionals and the public-at-large, we review the strengths and weaknesses of randomized trials in revascularization and highlight (1) when referral for consideration of diagnostic workup and therapy may be warranted, (2) the evidence/rationale for these selective scenarios, (3) interventional and surgical techniques for effective revascularization, and (4) areas of research with unmet need.
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Funes Hernandez M, Bhalla V, Isom RT. Hypothesis: Accessory renal arteries may be an overlooked cause of renin-dependent hypertension. J Hum Hypertens 2022; 36:493-497. [PMID: 34785773 DOI: 10.1038/s41371-021-00632-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/14/2021] [Accepted: 10/26/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Mario Funes Hernandez
- Stanford Hypertension Center, Stanford University School of Medicine, Stanford, CA, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Vivek Bhalla
- Stanford Hypertension Center, Stanford University School of Medicine, Stanford, CA, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert T Isom
- Stanford Hypertension Center, Stanford University School of Medicine, Stanford, CA, USA. .,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Tom D, Manvikar P, Mutalik M. Fetal accessory renal arteries and other renal anomalies. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_65_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Karadağ C, Birge O, Bakir MS, Doğan S, Tuncer HA, Şimşek T. Encountering the accessory polar renal artery during retroperitoneal lymphadenectomy. Clin Case Rep 2021; 9:177-179. [PMID: 33505687 PMCID: PMC7813120 DOI: 10.1002/ccr3.3493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
Because of the accessory polar renal artery (APRA) is functional, it is extremely important to be careful with vascular injuries, to prevent ischemic damage and not to cause kidney failure complications.
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Affiliation(s)
- Ceyda Karadağ
- Department of Gynecological OncologyAkdeniz University Faculty of MedicineAntalyaTurkey
| | - Ozer Birge
- Department of Gynecological OncologyAkdeniz University Faculty of MedicineAntalyaTurkey
| | - Mehmet Sait Bakir
- Department of Gynecological OncologyAkdeniz University Faculty of MedicineAntalyaTurkey
| | - Selen Doğan
- Department of Gynecological OncologyAkdeniz University Faculty of MedicineAntalyaTurkey
| | - Hasan Aykut Tuncer
- Department of Gynecological OncologyAkdeniz University Faculty of MedicineAntalyaTurkey
| | - Tayup Şimşek
- Department of Gynecological OncologyAkdeniz University Faculty of MedicineAntalyaTurkey
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Relationship between Accessory Renal Artery and Clinical Characteristics of Middle-Aged Patients with Primary Hypertension. Int J Hypertens 2020; 2020:7109502. [PMID: 32328302 PMCID: PMC7171647 DOI: 10.1155/2020/7109502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 03/06/2020] [Indexed: 01/18/2023] Open
Abstract
Objectives The association between accessory renal artery (ARA) and hypertension remains not fully understood. We observed the association between ARA and clinical characteristics among middle-aged patients with primary hypertension. Methods One hundred and sixty-two middle-aged (mean 39.82 ± 10.25 years, 58.0% male) patients with primary hypertension were enrolled, and patients underwent Computed Tomography Angiography (CTA) of renal arteries, ambulatory blood pressure monitor (ABPM), echocardiography, physical examination, and routine blood chemistry examinations. According to the CTA results, patients were divided into a non-ARA (n = 108) and ARA (n = 54) group. Direct renin concentration (DRC), plasma aldosterone concentration (PAC), ABPM, echocardiography, creatinine, and glomerular filtration rate were compared between the two groups. Results DRC (mU/L) (11.21 (5.34, 20.87) vs. 18.24 (10.32, 33.59), P=0.002) was significantly higher in the ARA group than in the non-ARA group. However, PAC (ng/dL) (98.30 (67.30, 134.00) vs. 116.50 (78.80, 137.25), P=0.103) was similar between these two groups. ABPM (mmHg) results showed that daytime (146.75 ± 17.04/95.86 ± 11.39 vs. 155.50 ± 14.76/100.48 ± 10.69, P < 0.05), night time (133.44 ± 17.50/85.28 ± 12.80 vs. 139.81 ± 14.64/89.83 ± 11.21, P < 0.05), and 24 h blood pressure (143.95 ± 15.99/93.90 ± 11.78 vs. 152.07 ± 13.85/98.11 ± 10.36, P < 0.05) were significantly higher in the ARA group than in the non-ARA group. Accordingly, echocardiographic-derived posterior left ventricular wall thickness value was higher in the ARA group than in the non-ARA group. Conclusion ARA is related to higher blood pressure and higher direct renin concentration in middle-aged patients with primary hypertension, and these patients deserve stricter blood pressure control. Our results provide important evidence for that ARA is a cause of hypertension and target organs damages.
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