Artikel
Aortitis as a possible cause of hypertension in the elderly: Diagnosis and follow-up
Aortitis als mögliche Ursache der arteriellen Hypertonie bei älteren Patienten: Diagnose und Verlauf
Suche in Medline nach
Autoren
-
F. Strutz
- Georg-August-University Medical Center, Göttingen (Göttingen, D)
-
A. Scheel
- Georg-August-University Medical Center, Göttingen (Göttingen, D)
-
J. Meller
- Georg-August-University Medical Center, Göttingen (Göttingen, D)
-
R. Vosshenrich
- Georg-August-University Medical Center, Göttingen (Göttingen, D)
-
E. Kohlhoff
- Georg-August-University Medical Center, Göttingen (Göttingen, D)
-
G. Müller
- Georg-August-University Medical Center, Göttingen (Göttingen, D)
| Veröffentlicht: | 11. November 2004 |
|---|
Gliederung
Text
Objectives
Hypertension is common in patients with Takayasu arteritis and is thought to reflect renal artery involvement due to aortitis. Conversely, giant cell arteritis is usually not associated with hypertension. However, using [18F]FDG-PET and MRI for screening, we have recently shown that giant cell arteritis may affect the aorta more commonly than previously thought. The aims of the current study were to study the incidence of hypertension and its correlation with imaging of aortitis with MRI and [18F]FDG-PET as well as clinical and inflammatory markers in the disease course.
Methods
We examined 8 elderly patients with aortitis presenting with unspecific GCA-like-symptoms. Aortitis was diagnosed by [18F]FDG-PET and MRI and follow-up examinations with both techniques were performed.
Results
7 of the 8 patients were hypertensive at diagnosis with a mean blood pressure of 149/83 mm Hg. There was a systolic blood pressure difference of more than 20 mm Hg in two of these patients. At diagnosis, 20 of 24 vascular regions were positive by [18F]FDG-PET scan and 15 of 21 aortic regions by MRI (one patient could not be examined by MRI due to cardiac pacemaker). Patients were treated with corticosteroids and followed for a mean of 13.3+4.7 months. In [18F]FDG-PET, 55 per cent of initially pathologic aortic regions were normalized in follow-up examination, which correlated closely with clinical and laboratory follow-up examination. Conversely, in MRI, 14 of 15 initially affected vascular regions were unchanged. Mean blood pressure was normalized to a mean of 123/73 mm Hg in all patients and no major blood pressure difference between arms was observed under effective therapy.
Conclusions
Our data indicate that hypertension has a high prevalence in patients with giant cell arteritis and involvement of the aorta. Though that does not demonstrate a causal relationship we propose that all patients with giant cell arteritis should be carefully screened and monitored for arterial hypertension. [18F]FDG-PET and MRI both are very effective techniques in detecting early aortitis with high correlation to laboratory inflammatory parameters. However, during follow-up examination, [18F]FDG-PET uptake decreased with clinical symptoms and inflammatory serum markers whereas MRI scans gave more static results.
