Medical therapy for renovascular hypertension: a review

Early medical treatment of renovascular hypertension with diuretics, vasodilators, and centrally acting agents was disappointing, with extended control of blood pressure achieved in only about 40% of patients treated. beta-Adrenergic blockers promised some improvement, but a high failure rate was still apparent. Because converting-enzyme inhibition appeared promising in early studies, we reviewed and analyzed the records of 269 patients with documented renovascular hypertension who were treated with captopril in worldwide trials. Captopril produced complete control of blood pressure in 74% of patients assessed at three months and partial control in an additional 8%. Thirteen percent of patients were discontinued for side effects that occurred, in part, due to the aggressive early captopril-dosing regimen. The drug was clearly ineffective in only 5% of patients. Progressive renal failure sufficient to warrant discontinuation of treatment occurred in only 5% of patients, generally in association with bilateral disease or a solitary kidney. Diagnostic and treatment issues are discussed. Medical therapy with a converting-enzyme inhibitor represents a viable alternative in selected patients with renovascular hypertension, especially those in whom there is a contraindication to surgery or angioplasty.