The aim of this work was to study in Takayasu's disease, clinical patterns, therapeutic particularities and the outcome of patients with hypertension.
Design and Method:
Among a cohort of 32 unrelated Takayasu's disease patients, followed over a 14-year period (1996–2009), 13 were included because of hypertension.
Results and Conclusions:
Mean age was 32.5 ± 12.4 years. Hypertension was a revealing symptom in one case and concomitantly discovered in 7 patients. Mean time lapse between first symptom and hypertension was 74 months in the other patients. Mean systolic blood pressure was 173 mmHg and diastolic blood pressure 102 mmHg. Besides hypertension, 4 patients presented one associated cardiac risk factor ie dyslipidemia in 1 case, smoking in 1, age over 60 years in 1 and obesity in 1 case. Target organ disease investigation revealed left ventricular hypertrophy in 3 cases, chronic renal failure in 3 cases, retinopathy in 2 cases and protenuria in 1 case. Hypertension mechanisms are often complex and intricate. Hypertension was due to renovascular disease in 6 patients. Unilateral renal artery stenosis was observed in 3 cases and bilateral in 3 cases. Three patients had associated lesions of the aorta involving the supra-aortic trunks and the renal arteries. Eleven had lesions of the supra-aortic trunks. In 9 cases, the carotid lesions with baroreceptor's hyposensitivity, presumably contributed to the genesis of hypertension. The steroid's iatrogenic effect contributed in 5 patients. Antihypertensive drugs were prescribed in 6 patients. Ten previously received steroid therapy which was secondary associated to immunosuppressive drugs. Renal artery endo-luminal angioplasty was attempted twice in 2 cases. First case constantly failed, but second underwent successfully bilateral aorto-renal bypass. Hypertension incidence in Takayasu's disease is hard to appreciate because blood pressure is often up- or under-estimated when supra-aortic trunks and the 2 sub-clavian arteries were involved altering hence wave pulse propagation and blood pressure clinical assessment. Hypertension over- demonstration and -estimation may have major therapeutic and iatrogenic consequences.