[Renovascular hypertension: invasive percutaneous diagnosis and therapeutic possibilities]

Under the current conditions of improved pharmacological therapy of arterial hypertension there is a danger that the physician may overlook considering the possibility of underlying renovascular causes for the hypertension. However, the diagnosis and treatment of these conditions are simple and easily accessible. Digital subtraction angiography is a simple technique which enables the diagnosis of renal artery stenosis or stenosis of the aorta to be made as a cause of hypertension in more than 90% of cases. Dependent on the type, extent and location of obliteration in the renal arteries, percutaneous transluminal-renal dilatation with a balloon-catheter is quite frequently the intervention of choice. In fibromuscular dysplasia the results are excellent, with a cure rate exceeding 90%, the patients being predominantly younger and females dominating. In stenosis of atherosclerotic origin, 40-60% show improvement or even normalization of blood pressure. A sudden recurrent increase in blood pressure during long-term follow-up requires angiography in order to perform either dilatation again or surgical reconstruction. In all cases of renovascular hypertension, interdisciplinary cooperation between surgeons and interventional radiologists is essential and all patients with renal insufficiency require close contact to a dialysis centre.