Reversal of renovascular hypertension

The fall in blood pressure observed in both early and chronic phase Goldblatt 2-kidney 1-clip hypertension produced by removing or unclipping the ischaemic kidney is due to a profound fall in peripheral resistance. The two procedures have an equal effect upon peripheral resistance and the lesser efficacy of nephrectomy in lowering blood pressure is due to a greater rise in stroke volume perhaps associated with a greater degree of sodium retention. Neither changes in sodium balance, in the renin-angiotensin system nor in vascular reactivity explain the fall in blood pressure. A reduction in renal sympathetic afferent activity and a medullary based vasoactive humoral system may play a role although the nature and extent of that role remain to be defined.