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Renovascular hypertension update.

Stephen C Textor1

  • 1Division of Nephrology and Hypertension, Department of Internal Medicine, 200 First Street, Mayo Clinic, Rochester, MN, 55905-0002, USA. stextor@mayo.edu

Current Hypertension Reports
|November 8, 2006
PubMed
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Managing hypertension in renovascular disease is challenging. Optimal treatment, balancing drug therapy and revascularization, remains under investigation, particularly for atherosclerotic lesions.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Medicine

Background:

  • Renovascular disease presents a significant clinical challenge in managing hypertension.
  • Advancements in imaging, drug therapy, and interventions complicate optimal patient management.
  • Renal artery disease exacerbates hypertension, activating pressor systems and causing target organ damage.

Purpose of the Study:

  • To review the complexities of managing hypertension in patients with renovascular disease.
  • To discuss the controversies surrounding renal revascularization, especially in atherosclerotic cases.
  • To highlight the importance of ongoing trials like CORAL in defining optimal treatment strategies.

Main Methods:

  • Review of current clinical challenges and treatment modalities for renovascular hypertension.

Related Experiment Videos

  • Discussion of patient populations, including younger individuals with fibromuscular disease and older patients with atherosclerosis.
  • Emphasis on the design and significance of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial.

    • Main Results:

    • Fibromuscular lesions in younger patients often benefit from renal revascularization with low risk.
    • Atherosclerotic renal artery stenosis is common in older patients with comorbidities, and intervention benefits are debated.
    • Previous trials showed limited advantages of angioplasty over medical therapy, with high crossover rates.

    Conclusions:

    • Optimal management of renovascular hypertension requires careful patient selection for interventions.
    • The role of renal revascularization versus medical management, particularly for atherosclerotic lesions, remains controversial.
    • The outcomes of trials like CORAL are crucial for establishing evidence-based guidelines for renal artery stenosis treatment.