KLINIČKE OSOBITOSTI BOLESNIKA S RENOVASKULARNOM HIPERTENZIJOM

MARKO NIKOLIĆ, DUŠKO KUZMANIĆ, BOJAN JELAKOVIĆ, MARIO LAGANOVIĆ, TAJANA ŽELJKOVIĆ VRKIĆ, BORKA PEZO NIKOLIĆ

Cilj je rada usporediti vrijednosti relevantnih kliničkih varijabli u bolesnika s renovaskularnom hipertenzijom (RVH) i esencijalnom hipertenzijom (EH) u dijagnostičkom postupku. U bolesnika s RVH odredili smo razlike između onih sa stenozom zbog aterosklerotske bolesti (ATH) i onih s fibromuskularnom displazijom (FMD). Dijagnoza RVH postav­ljena je na temelju nalaza renalne angiografije, kojom smo definirali vrstu stenoze (ATH ili FMD). Skupina bolesnika sasto­jala se od 108 bolesnika s RVH-ATH (46 m/62 ž) prosječne dobi 53 godine, 16 bolesnika s FMD (3 m/13 ž) prosječne dobi 49 godina te 106 bolesnika s EH (61 m/45 ž) prosječne dobi 38 godina. Bolesnici s RVH-ATH značajno su se razlikovali (p<0,05) od bolesnika s EH u zastupljenosti spolova (u RVH-ATH značajno više žena) te ostalim kliničkim pokazateljima, npr., imali su manju tjelesnu masu i visinu, bili su stariji, češće su uzimali antihipertenzive, a AH se javljala u kasnijoj dobi i bila je težih stadija. U skupini RVH-ATH žene su bile češći pušači cigareta te je u njih bila statistički značajno češće prisutna hiperkolesterolemija (p<0,05) čime bi se mogla objasniti veća učestalost ženskog spola u skupini bolesnika s RVH-ATH. U naših bolesnika s RVH-FMD također je statistički značajno (p<0,05) učestaliji ženski spol, ali je trajanje AH u većeg broja bolesnika kraće od 5 godina, uz manje serumske vrijednosti kreatinina i triglicerida u odnosu na RVH-ATH. Naši rezultati u skladu su s rezultatima drugih autora koji su pokazali kako klinički pokazatelji mogu biti korisni u probiru bolesnika za daljnju dijagnostičku obradu. To potvrđuje važnost temeljite anamneze, kliničkog pregleda i ciljanih laboratorijskih pre­traga. Na taj se način ne može jasno postaviti ili isključiti dijagnoza RVH, ali to može biti korisno u probiru bolesnika s AH za daljnju bolničku obradu, tj. renalnu angiografiju, a i pri donošenju odluke o načinu liječenja bolesnika s RVH.

Summary. The aim of our study was to show the value of comparing clinical parameters in patients with renovascular hypertension (RVH) and essential hypertension (EH). We examined the differences between renovascular hypertension patients with atherosclerosis (ATH) and those with fibromuscular dysplasia (FMD). The diagnosis of renovascular hyper- tension was established on the basis of renal angiography finding, which also defined the type of stenosis (ATH or FMD). Our patient group included 108 patients with atherosclerotic RVH (46 male / 62 female, median age 53 yrs), 16 patients with FMD (3 male / 13 female, median age 49 yrs), and 106 patients with EH (61 male / 45 female, median age 38 yrs). In com- parison with patients with EH, patients with atherosclerotic RVH were found to be more frequently of female gender with lower body weight and height, older, and more frequently on therapy with antihypertensives. Their hypertension was of later onset and more severe stage. All those differences were statistically significant (P<0.05). When analysis by genders was performed, women were more frequently smokers and had higher serum cholesterol levels, which is an explanation for higher proportion of female gender in atherosclerotic RVH patients. In patients with fibromuscular dysplasia a higher proportion of female gender was also present, but in comparison with ATH patients their hypertension was more often of a less than 5 years duration and they had lower serum creatinine and triglyceride levels. Our results are in agreement with the results of other authors who showed clinical parameters to be useful in screening of patients for further diagnostic procedure. This stresses the importance of good history, physical examination and well-chosen laboratory tests. They can’t clearly establish or exclude the diagnosis of renovascular hypertension, but this approach could more easily point out those hyper- tensive patients who require a thorough work-up. Clinical parameters could furthermore help in determining the type of treatment of RVH.