Are your kidneys the cause of your high blood pressure? Let's talk about Renovascular Hypertension

Are you also taking medicine for your blood pressure , but it still doesn't go down? Maybe your doctor says, "Even after giving you several types of medicine , your blood pressure won't go down." Sometimes, no matter how much you change your lifestyle, control your diet , and exercise, your blood pressure can still be high. At times like these, we should think that the cause may be a problem with the kidneys. Today we are going to talk about such a situation.

Simply put, what is renovascular hypertension?

Although the name sounds a bit complicated, the story is very simple. Renovascular Hypertension is high blood pressure caused by a problem with your kidneys .

Think about it this way. The kidneys are one of the most important organs in our body. Their main job is to filter the blood and remove waste products as urine . To do this job properly, the kidneys need a good blood supply. The main blood vessels ( arteries ) that carry blood to the kidneys are called `renal arteries`.

Now imagine that for some reason these blood vessels gradually become narrowed or thinned. Like a water pipe being squeezed in the middle. What happens then? The amount of blood that reaches the kidneys decreases.

When blood flow decreases like this, our intelligent kidneys think, “Oh, my blood pressure is low throughout the body, that’s why I’m getting less blood.” So, because they want to do their job properly, they take steps to increase the blood pressure in the body. To do that, they activate a hormonal system in the body. In medical terms, we call this the RAAS (Renin-Angiotensin-Aldosterone System) . When this hormonal system is activated, the blood vessels throughout the body constrict, and blood pressure rises.

This is not the same as normal blood pressure. This falls into a category called secondary hypertension. That is, high blood pressure caused by another medical condition.

What are the symptoms of this condition? How do we suspect it?

The biggest problem here is that there are usually no specific symptoms for this condition. That means you may not notice anything different. However, when a doctor looks at your medical history and the medications you take, he or she may pick up some clues. These are the things that make a doctor suspect this.

Let's see what those clues are.

Why is this happening? What are the main reasons?

The main cause of blockage of the blood vessels leading to the kidneys is a condition called renal artery stenosis . This means that the arteries in the kidneys become narrowed. There are two main reasons for this.

1. Atherosclerosis: This is the most common cause. Simply put, it is the gradual narrowing of the blood vessels due to the buildup of fat and cholesterol (called `plaque`) on the walls of the blood vessels. This is more common with age, diabetes, high cholesterol, and smoking.

2. Fibromuscular Dysplasia (FMD): This is a rare condition. It occurs when the cells (muscle and fibrous cells) in the walls of blood vessels grow abnormally, causing the blood vessels to narrow in places. This condition is most common in young women.

In addition to these two main reasons, there may be several other rare reasons.

What complications can occur if this is ignored?

Like any type of high blood pressure, this condition can lead to serious complications if left uncontrolled for a long time.

• Heart damage: Long-term high blood pressure can cause the heart to work harder, leading to conditions such as thickening of the heart muscle, heart attack, and heart failure.
• Further damage to the kidneys: The kidneys, which already have reduced blood flow, can be further damaged by high pressure, leading to kidney failure.
• Eye damage: Damage to the delicate blood vessels in the eye can lead to vision loss (retinal disease).
• Stroke: Damage to the blood vessels leading to the brain increases the risk of stroke.

How exactly does the doctor find this?

If your doctor suspects this condition, he or she will work like a detective, piecing together clues to arrive at a conclusion. This process involves several key steps.

1. Physical examination: The doctor will examine you, especially placing the stethoscope on your abdomen to check for the 'bruit' sound we mentioned earlier.

2. Asking about your medical history: You will be asked a lot of questions, such as the age at which you developed high blood pressure, whether anyone in your family has it, what medications you are taking, and whether you have any other illnesses.

3. Special tests: Several tests will need to be done to confirm the suspicion.

• Blood tests: Check kidney function (creatinine, eGFR) and hormone levels of the RAAS system.
• Urine tests: Check for things like protein in the urine.
• Kidney Ultrasound Doppler: This is the most important test. It measures the speed of blood flow in the arteries that carry blood to the kidneys and can accurately detect any blockages.
• Other scans: In some cases, more complex scans such as a CT angiogram or MR angiogram may be recommended.

Okay, now let's talk about treatment.

Once this condition is diagnosed, there is nothing to fear. There are effective treatments for this. The main goal of treatment is to control blood pressure and protect the kidneys and other organs.

Medicines (drugs)

In most cases, this condition can be well controlled with medication. In addition to the medications given for normal blood pressure, the doctor will prescribe medications that are specific to this condition.

• Angiotensin-Converting Enzyme (ACE) Inhibitors: For example, medications like Enalapril and Lisinopril.
• Angiotensin Receptor Blockers (ARBs): For example, medications like Losartan and Telmisartan.

Both of these medications control the activity of the RAAS hormone system we talked about earlier and stop blood pressure from rising.

In addition, other medications such as cholesterol-lowering statins, calcium channel blockers, and diuretics may be prescribed depending on your condition.

Procedures to be performed if necessary

Sometimes it's difficult to control your blood pressure with medication alone. Or if the blood vessel is severely blocked, your doctor may suggest a special procedure.

• Renal Artery Angioplasty and Stenting: This is similar to angioplasty for the blood vessels in the heart. A thin tube is inserted through a vein in the leg or arm and advanced to the blocked renal artery. The tube is then inflated with a small balloon to widen the blocked area. To prevent it from getting blocked again, a small mesh-like tube (a stent) is placed in the area.

• Renal Denervation: This is a relatively new treatment. It uses heat or ultrasound energy to reduce the activity of the nerves around the renal artery. These nerves are the ones that send signals to the brain to increase pressure. So by reducing their activity, blood pressure can be reduced.

Surgery

Surgery is rarely resorted to. Surgery is only resorted to if the structure of the blood vessels is too complex for procedures such as angioplasty to be performed, or if those methods fail.

• Surgical Renal Revascularization: This is also called renal bypass surgery.Here, the surgeon uses a piece of blood vessel taken from another part of your body or an artificial tube to create a new path (bypass) to carry blood to the kidney, bypassing the blocked part.

What happens after treatment?

Don't think that everything is over once you start treatment. It is essential to attend follow-up appointments as directed by your doctor.

In these clinics, Dr.

• They measure your blood pressure and see how successful the treatment is.
• Blood tests are performed to monitor kidney function.
• If necessary, your medication dosage will be changed or new medications will be added.

These appointments are very important for you too. This is a good opportunity to ask the doctor any questions or concerns you may have.

Can this condition be completely cured?

Renovascular hypertension is a treatable condition. That means that with the right medication and, if necessary, appropriate interventions, your blood pressure can be brought down to a healthy level. But it's more accurate to say that it can be "well-controlled" rather than "cured completely."

• Take your medication on time: Take your medication exactly as prescribed by your doctor, without skipping a single day.
• Take care of your diet: Reduce foods high in salt, oil, and sugar. If your doctor recommends a special diet like the DASH diet , follow it.
• Exercise: Ask your doctor what exercises are right for your body and how long you should do them, and act accordingly.

Once you know that this is the cause of your uncontrollable high blood pressure, you will feel a great sense of relief. Because now that you know the cause, you can get the right treatment for it. So, if you have any questions about this, don't be afraid to talk to your doctor.

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