中年左侧肾动脉狭窄导致难治性高血压1例并文献复习  

Refractory hypertension induced by left renal artery stenosis in middle-aged individuals:a case report and literature review

作　　者：房益伟 况春燕 FANG Yiwei;KUANG Chunyan(Zunyi Medical University,Zunyi,Guizhou 563006,China;Cardiovascular Department of Guizhou Provincial People’s Hospital,Guiyang,Guizhou 550002,China)

机构地区：[1]遵义医科大学,贵州省遵义市563006 [2]贵州省人民医院心内科,贵州省贵阳市550002

出　　处：《中国动脉硬化杂志》2025年第3期251-256,共6页Chinese Journal of Arteriosclerosis

基　　金：贵州省第十二批优秀青年科技人才项目(黔科合平台人才[2019]5662)。

摘　　要：肾动脉狭窄性高血压是继发性高血压常见类型之一,临床上主要表现为肾素和醛固酮水平升高,肾功能异常以及药物难以控制的难治性高血压。该文报道了1例动脉粥样硬化性肾动脉狭窄导致的难治性高血压病例,并复习相关文献。该患者为中年男性,在口服苯磺酸氨氯地平、盐酸特拉唑嗪、厄贝沙坦、卡维地洛、琥珀酸美托洛尔和盐酸地尔硫卓等药物的情况下,仍不能控制血压在理想范围内,需硝酸甘油持续泵入降压。进一步查肾动脉血管成像提示左肾动脉起始处重度狭窄,在接受肾动脉狭窄处支架植入术后,仅口服盐酸特拉唑嗪、苯磺酸氨氯地平及盐酸地尔硫卓,血压即可控制达标。导致继发性高血压的原因众多,该文就肾动脉狭窄这一常见病因作为切入点展开论述,以加深对继发性高血压的认识和理解,减少漏诊或误诊的发生。Renal arterial stenosis(RAS)hypertension is one of the common types of secondary hypertension.The main clinical manifestations are increased levels of renin and aldosterone,abnormal renal function and refractory hypertension that is difficult to control by drugs.In this paper,a case with refractory hypertension due to atherosclerotic renal artery stenosis was reported and the relevant literature was reviewed.The patient was a middle-aged male who could not control his blood pressure within the ideal range despite oral administration of amlodipinebesylate,terazosinhydrochloride,irbesartan,carvedilol,metoprololsuccinate,diltiazium hydrochloride and other drugs,requiring continuous pumping of nitroglycerin to lower blood pressure.Furthermore,the examination of renal artery angiography revealed severe stenosis at the origin of the left renal artery.After stent implantation at the renal artery stenosis,blood pressure could be controlled to the standard by oral administration of terazosin hydrochloride,amlodipine besylate and diltiazem hydrochloride only.There are many reasons leading to secondary hypertension.This paper discusses the common causes of renal artery stenosis as a starting point,in order to deepen the understanding of secondary hypertension and reduce the occurrence of missed diagnosis or misdiagnosis.

关 键 词：肾动脉狭窄 动脉粥样硬化 肾功能不全 继发性高血压 难治性高血压 

分 类 号：R5[医药卫生—内科学]