Severe Malignant Hypertension following Renal Artery Embolization: A Crucial Role for the Renal Microcirculation in the Pathogenesis of Hypertension?

Malignant hypertension is the most severe form of hypertension that is usually fatal if not properly managed. It is usually associated with evidence of microvascular damage such as retinopathy and nephropathy. Renal artery embolization is a widely utilised tool for the management of a wide range of conditions including drug resistant renovascular hypertension in patients with end stage renal failure. In this report we describe two patients with mild-to-moderate hypertension who underwent renal artery embolization for reasons unrelated to their hypertension. Contrary to conventional wisdom, in both patients hypertension became more severe and difficult to control. This report describes the cases and discusses the implications for current theory and the possible role of the microcirculation in the causation of hypertension.