Dottorato in ARTERIAL HYPERTENSION AND VASCULAR BIOLOGY

Titolo della tesi: RENOVASCULAR HYPERTENSION IN ELDERLY POPULATION AND HYPERALDOSTERONISM IN PREGNANT WOMEN: TWO FORGOTTEN CAUSES OF ARTERIAL HYPERTENSION

Secondary forms of arterial hypertension can be sporadic or familial and their prevalence is markedly under estimated since they are under suspected and, therefore, under diagnosed. Even if the first worldwide death cause are cardiovascular diseases, the screening for secondary, and therefore potentially curable, forms of arterial hypertension is not yet systematically applied in hypertensive patients. Skipping the diagnosis in these patients not only prevents the cure of their hypertension, but also prevents the resolution/amelioration of the related target-organ damages. Each period of the life has his own most prevalent forms of secondary hypertension, that should be suspected and excluded when a hypertensive patient is evaluated by means of tools that currently allow to make the diagnosis easily in most cases. My thesis was aimed at providing a comprehensive description of two forgotten forms of secondary hypertension: renovascular hypertension caused by atherosclerotic lesions of one/both renal arteries and hyperaldosteronism in fertile women. The former is prevalent in an elderly population with multi-district atherosclerosis, that is also the responsible of the under diagnosed Pickering Syndrome. The latter, that can be sporadic or familial, should be ruled out in hypertensive fertile women before planning a pregnancy since pregnancies in the affected women are at higher risk of maternal and foetal complications if the cause of the hyperaldosteronism is not removed before conception. This Ph.D. thesis is divided in four chapters: the first two are dedicated to renovascular hypertension caused by atherosclerosis, the last two are devoted to primary aldosteronism in fertile women that have a pregnancy.