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Hypothesis: Accessory renal arteries may be an overlooked cause of renin-dependent hypertension

Journal of Human Hypertension volume 36, pages 493–497 (2022)Cite this article

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Hypertension affects approximately 105 million people in the United States, almost half of the adult population [1]. The prevalence of renovascular disease as a cause of hypertension is 1–2% in the general population with hypertension; but greater than 5% in hospital-based cohorts, the elderly population, or in patients with systemic atherosclerotic vascular disease. In patients with severe or malignant hypertension, the prevalence of renovascular disease may be as high as 10–40% [2,3,4,5,6]. Renovascular disease is caused by impairment of blood flow to the kidneys, which may lead to hypertension and chronic kidney disease, the latter often referred to as ischemic nephropathy. The existence of a pressor substance, renin, arising from the kidney was first demonstrated by Tigerstedt and Bergman in 1898 [7]. In seminal, follow-up studies beginning in 1934, Goldblatt established that restriction of renal blood flow causes hypertension [8, 9]. Subsequently two different groups, Fasciolo and Houssay from Argentina, and Page and Helmer from Indiana, attributed the generation of renal artery stenosis-induced hypertension to activation of the renin-angiotensin system [10,11,12,13,14]. Generation of renin due to the existence of accessory renal arteries is another possible etiology of renovascular, renin-dependent hypertension [15].

Accessory renal arteries are a common finding in the general population. The prevalence of accessory renal arteries varies significantly depending on the population studied, the definition of accessory arteries, and the diagnostic modality employed for their identification [16]. If one includes only arteries arising from the aorta, the prevalence of accessory arteries in the general population is ~30% [17,18,19,20,21,22]. The hypothesis that accessory renal arteries associate with hypertension was first advanced in the 1950s, with studies comparing the prevalence of accessory renal arteries in patients with and without hypertension.

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Fig. 1: Multidetector CT angiography.
Fig. 2: Multidetector CT angiography.

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Authors and Affiliations

  1. Stanford Hypertension Center, Stanford University School of Medicine, Stanford, CA, USA

    Mario Funes Hernandez, Vivek Bhalla & Robert T. Isom

  2. Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Mario Funes Hernandez, Vivek Bhalla & Robert T. Isom

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MFH drafted the paper. VB and RI contributed equally in an oversight, supervisory role.

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Correspondence to Robert T. Isom.

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Funes Hernandez, M., Bhalla, V. & Isom, R.T. Hypothesis: Accessory renal arteries may be an overlooked cause of renin-dependent hypertension. J Hum Hypertens 36, 493–497 (2022). https://doi.org/10.1038/s41371-021-00632-2

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