Renovascular hypertension. Diagnosis and intervention

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Interventional Radiology

Background:

• Hypertension is a significant health issue, with a key challenge being the differentiation of essential hypertension from surgically curable renal vascular disease.
• Current diagnostic tests like renography and plasma renin activity assays (before and during angiotensin II blockade) are suboptimal.
• Advances in surgical techniques and percutaneous transluminal renal angioplasty (PTRA) necessitate improved screening methods.

Purpose of the Study:

• To highlight the diagnostic challenges in identifying renovascular hypertension.
• To emphasize the growing importance of effective screening tests in the context of advanced interventional treatments.
• To discuss the implications of percutaneous transluminal renal angioplasty for managing renal artery stenosis.

Main Methods:

• Review of diagnostic challenges in differentiating essential hypertension from renal vascular disease.
• Discussion of existing diagnostic modalities (renography, plasma renin activity).
• Evaluation of the role and risks associated with percutaneous transluminal renal angioplasty for renal artery stenosis.

Main Results:

• Existing diagnostic tests for renal vascular disease are unsatisfactory.
• Percutaneous transluminal renal angioplasty is the preferred treatment for hemodynamically significant renal artery stenoses when feasible.
• The risk of 'cosmetic repair' (treating non-hemodynamically significant stenosis) has increased with improved angioplasty techniques.

Conclusions:

• Accurate diagnosis of renovascular hypertension requires confirmation after successful correction of renal artery stenosis and normalization of blood pressure.
• Randomized trials comparing surgical and angioplasty interventions are currently lacking.
• There is a critical need for superior screening tests to identify patients who will benefit from interventions for renal vascular disease.