Prevalence of Renal Artery Stenosis in Hypertensive Patients on Treatment Undergoing Coronary Angiography; In Multi Cardiac Centers

Objective: Renal artery stenosis (RAS) is a vascular disease that has a massive impact on cardiovascular health of patients with hypertension and coronary artery disease (CAD). It is a constriction of the renal artery(s) or arteries, causing less blood access to the kidneys and resulting in permanent high blood pressure, and eventual kidney failure. Uncontrolled hypertension is considered to be one of the predisposing factors and outcomes of RAS. Hypertension is a significant cause of stroke, heart attack and kidney disease and affects over 21 percent of the world adult population. Dysfunction in renal perfusion initiates the reninangiotensin-aldosterone system (RAAS) leading to the release of angiotensin II and aldosterone which elevates blood pressure by causing vasoconstriction and sodium reabsorption. This produces a vicious cycle whereby hypertension worsens the RAS and CAD. Renal artery stenosis makes CAD more difficult by enhancing myocardial ischemia because decreased renal blood flow imposes additional hemodynamic load on the heart, and it may trigger cardiac events. Thus, the maintenance of renal perfusion and blood pressure should be carefully combined with the efforts of interventional radiologists, cardiologists, and nephrologists.Design and method: The cross-sectional study. This study was conducted at the Iraqi Center of Heart Diseases and Baghdad Cardiac Center Iraq from 1st August 2023 to 30th June 2024. Sixty hypertensive patients who experience elective coronary angiography were enrolled. They were divided into two groups, controlled and uncontrolled hypertension. Results: The mean age was 61.4 years and 53.3% males. The majority of them had uncontrolled hypertension (70%), diabetes (60%), and dyslipidemia (65%). Abnormalities were observed in 41.7 percent of patients on coronary angiography and the severe coronary disease was present in 25 percent. RAS was identified in 15 per cent and had a strong correlation with the abnormal angiography coronary findings (P = 0.002) and ineffective control of hypertension (P = 0.033). There was no significant correlation with diabetes, dyslipidemia, smoking, and echocardiographic outcomes. Conclusions: The renal artery stenosis is common in hypertensive patients undergoing coronary angiography, strongly correlates with coronary artery disease, influenced by hypertension control, while diabetes, dyslipidemia, smoking, and echocardiography show no significant association.