Renovascular Hypertension: An Etiology of Secondary Hypertension

Hypertension is still becoming major concern in health issues, regarding complication toward cerebral-cardiovascular. Secondary hypertension is type of hypertension with identifiable cause, one of aetiologies is renovascular hypertension caused by stenosis of renal artery. We report a case of 32-years-old women who was diagnosed renovascular hypertension. Our patient had hypertension before age of 30-years. She was referred to nephrology clinic because of having blood-pressure 230/120 mmHg although she didn’t complaint anything and found incidentally due to routine physical examination. For the last 4 years, she had been treated with amlodipine 10 mg, ramipril 10 mg, and hydrochlorothiazide 25 mg, but her lowest blood pressure examinations were 160/90 mmHg. Based on her history, she never had stroke, heart diseases, hyperthyroid, glomerulonephritis, and other diseases. Both of her parents had hypertension that developed after 50 years. Physical examination revealed normal finding except body mass index was 25.34 kg/m 2 . Laboratory examination finding was normal kidney function (e-GFR 115 mL/min/1.73 m 2 ), uACR 87.3 mg/g-creatinine, normal potassium (3.5 meq/L), and no hematuria. Electrocardiogram revealed PVC bigeminy, but abdominal doppler ultrasound showed tardus-parvus renal artery suspected bilateral stenosis. Further examination test of CT angiography of the abdomen confirmed stenosis in left renal artery (76%) and right renal artery (50%). Thus, she was consulted to vascular surgeon to undergo stenting in arteries, proceed to biopsy because of suspected Takayasu arteritis as underlying of that stenosis. Ramipril was stopped, bisoprolol 5 mg od was given as part of drugs combination. Further progress is still observed until this moment.