Multidisciplinary expert consensus on the diagnosis and treatment of hypertension caused by middle aortic syndrome (2026)

Middle aortic syndrome (MAS) is a rare vascular disease characterized by segmental narrowing of the distal descending aorta and the upper abdominal aorta (i.e., the middle section of the aorta) due to congenital developmental abnormalities or acquired factors. It often involves visceral arteries and renal arteries, leading to a clinical syndrome manifested by hypertension, intermittent claudication, and heart failure. MAS accounts for 0.5% to 2.0% of aortic diseases and commonly occurs in children, adolescents, and young adults. Due to its complex influencing factors, domestic physicians have insufficient understanding of hypertension caused by MAS, which poses certain difficulties in diagnosis and timely treatment. Approximately 80% of untreated patients die from complications such as heart failure, cerebral hemorrhage, or aortic rupture before the age of 40. The diagnosis and treatment of this disease often require multidisciplinary cooperation and individualized approaches. To improve clinical physicians' ability to diagnose and treat this condition, this consensus was jointly drafted by experts from cardiology, vascular surgery, rheumatology and immunology, pediatrics, and medical imaging. It systematically elaborates on the concept, pathophysiological mechanisms, classification, and clinical characteristics of MAS, and provides recommendations for the diagnosis, evaluation, and treatment of hypertension caused by MAS, aiming to standardize diagnostic criteria and treatment strategies. Emphasis is placed on early recognition and multidisciplinary collaboration, with individualized treatment strategies proposed based on etiology, type of stenosis, and age. This consensus clearly outlines perioperative management key points and long-term follow-up plans, aiming to raise clinical physicians' awareness of hypertension caused by MAS and enhance their diagnostic and therapeutic capabilities.