Renovascular hypertension

Renovascular hypertension is caused by renovascular disease and it can be potentially cured by ablative or reconstructive operation or PTA. The incidence of renovascular hypertension is 1 to 2 per cent among nonselected hypertensive patients. Renovascular disease in hypertensive patients is progressive in 20 to 40 per cent. The diagnosis of renovascular hypertension can only be made retrospectively after successful intervention. The accuracy of all tests for the determination of the functional significance of a stenosis before intervention remains limited. It has been demonstrated that medical therapy, reconstructive surgical treatment and PTA each can effectively lower high blood pressure. Although medical therapy has been considerably improved because of the development of new drugs, it should be recognized that medical management does not prevent the natural progression of renovascular disease. Therefore, renovascular hypertension is best treated by correction of the underlying renal arterial stenosis. Improvements in surgical management include improved selection of patients for surgical treatment, increased beneficial blood pressure response rates in 70 to 95 per cent of the patients and decreased surgical mortality rates of less than 5 per cent. The anatomic failure rates have been reduced because of the increase in surgical expertise, the use of autologous materials for bypass, the avoidance of combined procedures in the event of concomitant aortoiliac disease, the use of extra-anatomic reconstructions when appropriate and the introduction of extra-corporeal reconstruction and autotransplantation. PTA has evolved as a relatively safe and effective method in the treatment of renovascular hypertension. However, complications do occur and orificial arteriosclerotic lesions and renal arterial branch lesions should not be considered for angioplasty. At present, the question of whether renovascular surgical treatment or PTA should be the treatment of choice cannot be answered completely. Treatment of renovascular hypertension should be accommodated to each patient.