Optimal medical management in patients with renovascular hypertension

Renovascular hypertension refers to the rise of arterial pressure due to reduced perfusion of the kidney caused by the stenotic renal artery/ies. The most common cause of stenotic renal artery is atherosclerosis. Atherosclerotic renal stenosis is usually part of a systemic syndrome that involves hypertension, intrinsic renal damage, and cardiovascular morbidity. So far, large trials have not proven the superiority of interventional therapies to medical management. As a result, renal artery stenosis should be treated mainly as a coronary artery disease equivalent focusing on rigorous management of hypertension, hyperglycemia, and hyperlipidemia. Antihypertensive treatment should include renin-angiotensin system blockade medication in most cases, while HMG-CoA reductase inhibitors (statins) can be used even in chronic kidney disease with safety. Lifestyle modifications, such as cessation of smoking, and antiplatelet therapy have reduced the risk of cardiovascular events in high-risk patients.