The role of radiology assistant at the possibilities of treatment of hypertension

Despite progress in diagnose and treatment, high blood pressure remains a serious problem; it brings higher risk of coronary, cerebrovascular and renal complications.The bachelor thesis is divided into a theoretical and a practical part. In the theoretical part, the conception of blood pressure is explained how it is measured and when we indicate it as elevated i.e. hypertension. Particular stages, classification and aetiology of hypertension are described. The thesis states circumstances which influence blood pressure (magnesium, natrium, calcium, obesity, alcohol, stress, sympathetic neural system, renal function, etc.). It describes several basal examinations for assessment of diagnosis of hypertension, regimen measures and pharmacological treatment. This part identifies organs at most significant risks (heart, central neural system, kidneys) and consequent diseases (vascular strokes, coronary heart disease, renal diseases). In the practical part, the results on basis of stated objectives are given. The thesis describes basic examinations leading to the confirmation of renovascular hypertension (ultrasound UZ, computed tomography CT, magnetic resonance MR, digital subtractive angiography DSA and methods of nuclear medicine). Stenosis of renal artery is the reason of 1-5% of all causes of hypertension but the causal link between narrowing of kidney artery and hypertension is not always proved. Stenosis can be solved by percutaneous angioplasty (PTA). This is described in the thesis: preparation of the patient, the performance itself, complications, costs. In the group of 36 patients after angioplasty of renal artery the demandingness, radiation onus and efficiency are evaluated. Although percutaneous angioplasty of renal artery is not technically difficult, decreasing of blood pressure will not occur at all patients. Not every stenosis participates at hypertension. The PTA was technically successful in all patients, radiation load did not overcome 100 Gycm?, blood pressure decreased at 31 cases and at 8 patients decreased also number of used medicines. Radiological assistant is present also at relatively new method of solution of resistant hypertension renal denervation. This catheter method at which sympathetic nerve fibres are ablated by radiofrequency is described in the thesis. Performance of renal denervation itself is not a demanding performance but it is a new and relatively expensive method not suitable for all patients with hypertension. Patients must be observed for longer time period. There were 42 denervations performed in the hospital of České Budějovice, all of them are included into examined group (No 2). All patients were without complications. There are assessed radiation dose during the performance (only in one case was higher than 100 Gycm?), amount of contrast agent and effect on blood pressure. Disposed local standard of percutaneous angioplasty will be loaded in the database in the hospital of Havlíčkův Brod, and in the angiology hall of this hospital in written form. The answer on the investigative question "Is intervention on renal arteries in comparison with new trends of pharmacotherapy beneficial for a patient?" is "Yes". Each of discussed catheter methods bring decrease of high blood pressure often insolvable by medicine, though not in all patients. The thesis provides enough information on hypertension, percutaneous angioplasty and renal denervations for paramedical staff and the general public