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Renovascular Hypertension: Novel Insights
Chrysoula Boutari1, Eleni Georgianou1, Alexandros Sachinidis1
1Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, 49 Konstantinoupoleos, Thessaloniki, 54642, Greece.
Current Hypertension Reviews
|May 1, 2019
Summary
Renovascular hypertension (RVH), caused by renal artery stenosis (RAS), is a reversible hypertension cause. Revascularization shows no superiority over medication, limiting its use to specific severe cases.
Area of Science:
- Nephrology
- Cardiology
- Vascular Medicine
Background:
- Renovascular hypertension (RVH) is a significant cause of secondary hypertension.
- Renal artery stenosis (RAS), due to atherosclerosis or fibromuscular dysplasia, underlies RVH.
- RVH can lead to renal damage, cardiovascular issues, and flash pulmonary edema.
Purpose of the Study:
- To review the causes, diagnosis, and treatment of renovascular hypertension.
- To evaluate the efficacy of renal artery revascularization versus medical therapy.
- To define current recommendations for RVH management.
Main Methods:
- Literature review of diagnostic modalities including Duplex Doppler ultrasonography, CT angiography, and MR angiography.
- Analysis of therapeutic options: medical management, percutaneous angioplasty, and surgical revascularization.
- Evaluation of evidence from major clinical trials comparing revascularization and medical therapy.
Main Results:
- Diagnostic methods like ultrasound and angiography are commonly employed.
- Medical therapy, angioplasty, and surgery are available treatments.
- Large trials did not prove revascularization superior to medication for blood pressure control or renal function preservation.
Conclusions:
- Renal artery revascularization is now reserved for specific RVH cases with worsening renal function or recurrent flash pulmonary edema.
- Further research is needed to identify patient subgroups that may benefit from revascularization.
- Current evidence supports medical management as a primary treatment for most RVH patients.
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