Secondary arterial hypertension of renal original, aortic aneurysms and their effects on driving
Arterial hypertension secondary to kidney disease is less frequent than essential hypertension, but it has serious repercussions on driving because of the seriousness of the AH which often incapacitates the driver
Stenosis of the renal artery is more frequent among men with arteriosclerosis or in women with fibromusclar dysplasia.
This is the primary cause of renovascular hypertension, which can appear without warning and be malign and refractory to treatment, meaning that in selected cases surgical revascularisation or renal angioplasty will be performed.
As a result of the obstruction of the renal artery, a kidney infarct can occur, which will cause serious pain, vomiting, high blood pressure, fever, etc. Renal function can be maintained thanks to the other kidney.
Interventional treatment will eliminate the blockage and allow the kidney to recover and AH to be brought under control. Anticoagulation is often associated.
Parenchymal renal diseases associated with AH can be bilateral due to glomerulonephritis and interstitial nephropathy, or unilateral caused by agnesia, tumours and hydronephrosis.
Arteriolar nephrosclerosis produced by sustained AH can cause kidney failure.
Malign nephrosclerosis causes a rapid elevation in blood pressure with serious symptoms and kidney failure.
The control of AH reverses all the symptoms in the majority of cases.
Aneurysms and acute aortic dissection
Dilatations of the aorta are usually caused by aterosclerosis and can be classified as authentic aneurysms and dessicant aneurysms.
A genuine aortic aneurysm is characterised by weakness of the arterial wall with dilatation and local or extensive affectation.
This can be asymptomatic, and the patient may undergo elective surgery.
The key symptom is pain, which is deep in the case of thoracic aneurysm, along with cough, dysphonia, dysphagia and haemoptysis among others.
In abdominal aneurysm, pain is severe and can be continuous or intermittent, in the lumbar or lumbosacral area and radiating to the lower limbs with the possibility of thromboembolisms here and all the clinical symptoms of acute ischemia.
Strict control of AH and the factors predisposing the patient are required.
Aneurysms measuring over 6 cm or under but showing rapid growth, necessarily require surgical treatment.
dessicant aneurysms and aortic dissection are associated with AH, cystic necrosis of the media and ateroesclerosis
Rupture of the aortic intima means that the blood that separates the rest of the arterial wall is threatened with rupture and death.
The immediate control of AH and the real situation of the aneurysm must be diagnosed in order to decide the best moment to carry out the surgical repairs.
Advice on Arterial hypertension secondary to kidney disease
- In this situation, driving is not permitted until the diagnosis is confirmed and the patient’s hypertension has been controlled by medical treatment using calcium channel blockers and angiotensin-converting enzyme inhibitors.
- The specialist will evaluate the results of the treatment established and indicate whether the patient is in a fit condition to drive once blood pressure is under control and there are no organic repercussions.
Advice on Acute occlusion of the renal artery
- Driving will not be permitted until the disease is under control and the patient is stabilised.
- Although the patient may feel he has recovered completely, he should not drive if there is a risk of a further ischemic event, for example when the emboligenic focus remains.
- Once the origin of the embolisms has been eliminated the patient will be allowed to drive if authorised by a specialist in a report.
- In the case of multiple embolisms the focus of origin must be found in order to choose the best treatment possible, which may, in some cases, be associated with an embolectomy.
- The patient must be warned that while taking anticoagulants he is at greater risk of haemorrhage resulting from even small collisions, and so he must drive extremely carefully.
Advice on Parenchymal renal diseases associated with AH
- If the patient evolves favourably with the treatment for the kidney disease causing the AH, the doctor can then go on to decide whether the patient is capable of driving, with blood pressure levels under control and without organ repercussions.
- Systemic diseases affecting the kidneys are common and serious in Polyarteritis nodosa, in disseminated erythematosus lupus and in many cases vasculitis.
- Sclerodermia can cause serious arterial hypertension because of the occlusion of the small arterioles in patients who are stabilised.
- Angiotensin enzyme converting inhibitors and dialysis can restore renal function and normalise arterial hypertension.
Advice on Secondary arterial hypertension of renal original
- Driving with severe renal conditions and difficult to treat AH is not permitted.
- Successful control of the illness causing the renal AH means the patient may drive again, when the specialist gives express permission.
Advice on Arteriolar nephrosclerosis produced by sustained AH
- The patient must not drive while suffering from symptoms, until the high blood pressure figures have been normalised with treatment and renal function has been restored.
- The doctor will report on the improvements in the patient’s evolution at each check up and will advise when safe driving is once again possible.
Advice on Aneurysms and acute aortic dissection
- Patients with small aneurysms should have their AH strictly controlled and be warned of the risks of driving with high blood pressure.
- An unexpected blow to the abdomen, or the pressure of the seat belt on sudden braking can cause the rupture of a large aneurysm.
- Large, or quickly growing aneurysms mean driving should not be allowed until the situation has been resolved by surgical treatment and the patient has stabilised without complications or sequelae.
- Surgical intervention will require a post operative period of recovery appropriate to the patient, during which time driving must not be allowed.
- As the specialist observes improvements in the patient’s evolution after surgery, he will warn him of possible sequelae and when it will be safe for him to drive around without increased risk.
Advice on dessicant aneurysms and aortic dissection are associated with AH
- Driving is not possible until the aortic dissection diagnosed has been surgically repaired, and during the subsequent period if the patient is not stabilised or has complications.
- After surgery, the specialist will monitor the patient’s progress, warning him of possible sequelae and informing him when it will be safe for him to drive again without increased risk.
- If the patient suffers from sudden and intense thoracic pain, he should park the vehicle immediately and ask for urgent help. He shouldn’t try and drive himself to the emergency department of the hospital.
- A sudden blow to the abdomen or the pressure of the seat belt caused by slamming on the brakes can cause the definitive rupture of an aneurysm as the intima is not normal.