Renovascular hypertension: an update on pathophysiology, diagnosis and treatment.
Renovascular hypertension: an update on pathophysiology, diagnosis and treatment.
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肾血管性高血压：病理生理学、诊断和治疗的最新进展。
DOI：
10.1159/000166707
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发表时间：
1983
影响因子：
4.2
通讯作者：
Levin,DC
中科院分区：
文献类型：
--
作者：
Dzau,VJ;Gibbons,GH;Levin,DC
肾血管性高血压的临床问题为几代动物和临床研究提供了刺激。这项深入研究的结果大大提高了我们对这种疾病的发病机制以及血压调节的理解。正如Hollenberg b[1]所指出的，“……很少有实验室发现能像戈德布拉特1934年的实验翻译那样迅速地找到临床表现。就在戈德布拉特发表报告的三年后，巴特勒为一位患有肾性高血压的患者进行了肾切除术，并治愈了她的高血压。这种疾病的诊断、管理和治疗需要多学科的方法，包括放射学、医学和外科专业知识的结合。毫不奇怪，自Butler最初的治疗尝试以来，这些学科的进步都提高了临床干预的效果。肾血管造影术的发展有助于确定该疾病是否存在可通过血管重建技术进行纠正的解剖病变。自Goldblatt的研究以来，激素的改善，特异性激素阻滞剂的发展和创新的动物实验使人们对肾血管性高血压的病理生理学有了更好的理解。肾素分泌调节控制机制的定义提高了我们诊断疾病和预测手术结果的能力。肾素-血管紧张素系统药物抑制剂的最新发展为诊断提供了新的方法，并有望为治疗提供强有力的补充。最后，新的计算机化血管造影技术，如数字减影血管造影术，加上最近的非手术侵入性技术，如经皮腔内血管成形术，可能会彻底改变我们的诊断和治疗策略。即使在Goldblatt工作50年后，各学科最新进展的融合仍然使肾血管性高血压成为最令人兴奋和最具挑战性的临床问题。在这篇综述中，我们将强调该疾病的潜在病理生理学，并参考动物研究的最新进展。由于对这一问题的合理临床方法来源于对潜在机制的理解，各种临床问题将在病理生理学的背景下详细讨论。专门的部分致力于这种疾病的诊断和治疗的最新进展，如肾素-血管紧张素系统抑制剂的使用，数字减影血管造影术（DSA）和经皮腔内血管成形术（PTA）。另一方面，该病的流行病学或病理学已经在其他地方进行了广泛的综述，本文将不进行讨论。
The clinical problem of renovascular hypertension has provided the stimulus for generations of animal and clinн ical research. The results of this intensive investigation have significantly improved our understanding of the pathogenesis of this disease as well as the regulation of blood pressure in general. As Hollenberg [1] noted,'... rarely has a laboratory finding found clinical expresн sion as rapidly as did the translation of Goldblatt’s experн iments in 1934. Only three years after Goldblatt’s report, Butler performed a nephrectomy on a patient with renal hypertension and cured her hypertension’. The diagnosis, management and cure of this disease entails a multidisciplinary approach involving a combiн nation of radiological, medical, and surgical expertise. Not surprisingly, advancements in each of these disciн plines have improved the efficacy of clinical intervention since Butler’s initial therapeutic attempts. The developн ment of renal angiography helped define the disease in terms of an anatomic lesion amenable to correction by techniques of revascularization. Improved hormonal asн says, development of specific hormonal blockers and innovative animal experiments have resulted in a better understanding of the pathophysiology of renovascular hypertension since Goldblatt's studies. Definition of the regulatory control mechanisms involved in renin secreн tion have improved our ability to diagnose the disease and prognosticate surgical results. The recent developн ment of pharmacologic inhibitors of the renin-angiotenн sin system has provided new approaches to diagnosis and promises to contribute powerful additions to the theraн peutic armamentarium. Finally, new computerized raн diologic techniques such as digital subtraction angiograн phy coupled with recent nonsurgical invasive techniques such as percutaneous transluminal angioplasty can potenн tially revolutionize our diagnostic and therapeutic strateн gy. The confluence of recent advancements in each disciн pline still makes renovascular hypertension a most excitн ing and challenging clinical problem even 50 years after the work of Goldblatt.In this review, we will emphasize the underlying pathophysiology of the disease with reference to recent developments in animal studies. Insofar as a rational clinical approach to this problem is derived from the understanding of the underlying mechanisms, various clinical issues will be discussed in detail in the context of the pathophysiology. Specific sections are devoted to recent advances in diagnosis and therapy of this disease such as the use of renin-angiotensin system inhibitors, digital subtraction angiography (DSA), and percutaneous transluminal angioplasty (PTA). On the other hand, the epidemiology or pathology of this disease have been extensively reviewed elsewhere and will not be discussed in this paper.