Hypertension Grand Rounds Severe Hypertension With Large-Vessel Arteritis

Small-vessel arteritis is associated with hypertension because the commonest varieties, granulomatous vasculitis with polyangitis and microscopic polyangitis with antineutrophil cytoplasmic autoantibodies, usually cause necrotizing glomerular disease. Medium vessel vasculitis, such as polyarteritis nodosa and Kawasaki disease, are less regularly associated with hypertension. Large-vessel vasculitis, such as giant cell arteritis, commonly coincides with hypertension. Takayasu arteritis, a granulomatous inflammation of the aorta and its major branches, generally afflicts patients aged younger than 50 years. Mikito Takayasu1 first described the condition in a woman reporting visual loss. Takayasu found abnormal anastomoses on funduscopic examination termed “coronary anastomosis” of the retinal vasculature because of the corona-like vessel connections. Katsutomo and Tsurukichi described similar young female patients and made the observation that the patients had absent radial pulses. Takayasu arteritis is rare in Western countries. The disease has been described worldwide with an incidence of up to 3.3 per million and is most common in Asia. However, Takayasu arteritis is by no means confined to Asians and, because of current mobility, clinicians must be aware of the disease. Watts et al2 inspected the United Kingdom General Practice Research Database. The overall annual incidence of Takayasu arteritis was 0.8 per million with a prevalence of 4.7 per million. The annual incidence in those aged younger than 40 years was 0.3 per million. In the Norfolk Vasculitis Registry population, 1 patient was identified (0.4/million/yr) with 3 prevalent cases (7.1/million). Onset at age 40 years or younger, claudication of an extremity, decreased brachial artery pulse, 10 mm Hg, difference in systolic blood pressure between arms, a bruit, and narrowing or occlusion of the aorta and its major branches are included in the American College of Rheumatology criteria. The presence of 3 of these 6 criteria demonstrated sensitivity of 91% and a specificity of 98%.3