Renal Vascular Hypertension

Abstract

The blood pressure response to surgery or percutaneous transluminal angioplasty (PTA) was determined an average of 3 years after treatment. In atherosclerotic disease, 85% of patients benefited. Furthermore, the extremely low overall cure rate of 6% (4/67) suggests that renal artery stenosis due to atherosclerosis is rarely a sole cause of hypertension, but more likely is an atherosclerotic complication of essential hypertension that develops in patients who are cigarette smokers. In fibrodysplastic disease both treatments were likely to improve the blood pressure. However, surgery resulted in a 41% rate of loss of the operated kidney. The response to PTA or surgery is strongly influenced by the etiology of the lesion being treated.

Cure and Improvement of Renovascular Hypertension after Percutaneous Transluminal Angioplasty of Renal Artery Stenosis

“…The observed complication rate of 8% corresponds well with the experience of other authors [3][4][5][6][7]18], Com plications occurred more often in patients with AS than in those with FMD. An immediate surgical intervention was needed in 3 cases because of acute thrombotic occlu sion or dissection of the intima during PTA.…”

“…Various studies on the effect of PTA on renovascular hypertension report a cured and improved incidence of hypertension in 30-75% of patients with AS and in 80-95% of those with FMD [3][4][5][6][7], Therefore, PTA has become the favored method for treating renal artery stenosis in the majority of cases with renovascular hypertension.…”

“…Although various authors [3][4][5][6][7] used differing criteria for definition of cure, improvement or failure, in most studies 'improvement' was characterized by the fact that after angioplasty patients showed blood pressure values within the normal range but still required antihyperten sive medication. Comparison of blood pressure values in these patients is difficult since in a substantial part of cases classified as improved or unimproved antihyper tensive therapy was changed during follow-up.…”

“…Kidney function significantly improved in patients with cure, remained stable in those with improvement and worsened in cases classified as unimproved. These results document the good long-term effect of PTA on blood pressure and kidney function in patients with renal artery stenosis.Since the first description of a successful percutane ous transluminal angioplasty (PTA) of a renal artery stenosis in a patient with renovascular hypertension in 1978 [1], this simple and elegant procedure has been accepted worldwide as the favored treatment in the ma jority of patients with renovascular hypertension [2], Var ious authors [3][4][5][6][7] have reported their experience with PTA in patients with atherosclerotic stenosis (AS) as well as in those with fibromuscular dysplasia (FMD). In these studies the number of cases with cure of hypertension after PTA showed a range between 4 and 25% in patients with AS and between 48 and 58% in those with FMD, whereas improvement of hypertension was observed be tween 20 and 50% of cases with AS and between 29 and 48% in those with FMD, respectively.…”

Blood pressure and renal function before and after percutaneous transluminal renal angioplasty in fibromuscular dysplasia

“…Several studies have evaluated the efficacy of revascularization by percutaneous transluminal renal angioplasty (PTRA) in patients with FMD [1][2][3][4][5][6][7][8][9][10], but most of these were small and follow-up times were relatively short. In addition, no control groups were included.…”