Article Text
Abstract
Background: Hypertension is common in the antiphospholipid (Hughes) syndrome (APS) and its cause is poorly understood. Anecdotal evidence suggests that renal artery stenosis (RAS) may be a relevant and treatable cause of hypertension.
Objective: To investigate the prevalence of RAS in patients with APS and hypertension.
Patients and methods: Three groups of patients were evaluated: (1) 77 patients with positive antiphospholipid antibodies (aPL) (60 secondary APS, 11 primary APS, and 6 with aPL only) and uncontrolled hypertension who were receiving two or more antihypertensive drugs; (2) 91 patients (⩽50 years) attending hypertension clinics;(3) 92 normotensive healthy, potential renal transplant donors. Magnetic resonance renal angiography was used to image the renal arteries in all three groups.
Results: Group 1: 20/77 (26%) patients had evidence of RAS (16 unilateral and 4 bilateral). Sixteen patients (80%) had smooth well defined stenoses in the proximal third of the renal artery. Three further patients had irregular arteries without distinct stenosis. Group 2: 7/91 (8%) hypertensive patients had RAS (χ2=10.3, p<0.001 v group 1). Group 3: 3/92 (3%) healthy donors had RAS (χ2=18.2, p<0.0001 v group 1).
Conclusion: A significantly increased prevalence of RAS (26%) was found in patients with APS and hypertension, compared with relatively young (⩽50 years) hypertensive controls and healthy potential donors.
- antiphospholipid syndrome
- renal artery stenosis
- anticoagulation
- magnetic resonance imaging
- angioplasty
- aCL, anticardiolipin antibodies
- aPL, antiphospholipid antibodies
- APS, antiphospholipid syndrome
- BMI, body mass index
- CT, computed tomography
- INR, international normalised ratio
- MRA, magnetic resonance imaging angiography
- ox-LDL, oxidised low density lipoprotein
- RAS, renal artery stenosis
- SLE, systemic lupus erythematosus