Management of renovascular hypertension

Abstract

Purpose of review Renovascular occlusive disease remains a common cause of resistant and rapidly progressive hypertension. The present review summarizes current practice regarding management of renovascular hypertension (RVH). Recent findings Current data using blood oxygen level dependent MR emphasize the tolerance of the kidney to moderate reductions in blood flow and the efficacy of antihypertensive drug therapy for many individuals. Prospective trials have failed to identify benefits of revascularization for moderate disease, either regarding blood pressure or renal function. Antihypertensive drug therapy including renin-angiotensin system blockade is central to management of RVH. Recent and ongoing observational studies report important improvements after revascularization regarding blood pressure, management of refractory or ‘flash’ pulmonary edema, and survival in specific ‘high risk’ clinical populations not included in randomized trials. Research directions underscore the role of adjunctive measures, including mitochondrial protection, therapeutic angiogenesis, and cell-based regenerative repair to protect kidney function in RVH. Summary Clinicians should recognize the potential for disease progression to threaten renal function with severe and prolonged renal ischemia. Improved patient selection for true resistant hypertension with RVH and ‘high-risk’ clinical manifestations is critical to identify those likely to benefit from renal revascularization.

Renovascular Compression by the Diaphragmatic Crus: A Case Report

“…Medications used in RVHT angiotensin-converting enzyme inhibitor (ACEI)/ARB are the best options to start with. It showed an improvement in the survival rate [ 13 ]. Although ARB decreases the glomerular filtration rate (GFR) initially, it does not cause a long-term loss in renal function.…”

“…Renal revascularization endovascular or open are the surgical treatment method used in RVHT, with a preference for the endovascular method. Young aged patients with the non-atherosclerotic renovascular disease and others are among the factors favoring renal revascularization over medical treatment [ 13 ]. Despite the use of renal revascularization and surgery in the management of renal artery compression, they are associated with surgical complications and stent complications, and it has to be individualized.…”

Atherosclerotic renovascular disease and cardiovascular risk: new concepts

“…ARAS prevalence ranges from 30% among patients with coronary artery disease to 50% in elderly patients or in those with atherosclerotic lesions in different vascular territories. [1][2][3] Several reports have emphasized the common association of ARAS with documented CAD, and studies based on series of clinically selected groups indicated the prevalence of ARAS at 11% to 18%. [1][2][3] In the studies of Weber -Mzell et al 9 and Harding et al 11 performed in the cohorts of patients undergoing cardiac catheterization for suspected CAD, ARAS (defined as renal artery stenosis >50%) was found in 10.7% and 11% of patients, respectively.…”

“…[1][2][3] Several reports have emphasized the common association of ARAS with documented CAD, and studies based on series of clinically selected groups indicated the prevalence of ARAS at 11% to 18%. [1][2][3] In the studies of Weber -Mzell et al 9 and Harding et al 11 performed in the cohorts of patients undergoing cardiac catheterization for suspected CAD, ARAS (defined as renal artery stenosis >50%) was found in 10.7% and 11% of patients, respectively. In the study by Rihal et al, 12 which included 297 individuals who underwent coronary angiography, RAS of 50% or more was found in 9.2% of patients.…”

“…ARAS can cause serious cardiac complications, such as flash pulmonary edema or congestive heart failure (HF). [1][2][3] ARAS is a multifaceted disease due to the complex interplay between RAS, hypertension, and Introduction Renal vascular hypertension (RVHT) is one of the most common secondary forms of hypertension. It is estimated that 1% to 5% of all cases of hypertension can be attributed to this condition.…”