Medical treatment of renal artery stenosis: is it effective and appropriate?
Recent advances in endovascular technology have radically changed the options available for the clinical management of the patient with renovascular disease. These treatment options have fueled an ongoing debate concerning the appropriateness of interventional endovascular therapy for the stenotic renal artery versus conservative medical management. This review examines a typical clinical case scenario and analyzes relevant published literature and the recent guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) highlighting the significant shortcomings of evidence-based data when it comes to the management of this complex patient population. Early diagnosis provides the best opportunity for appropriate utilization of therapeutic options and rational timing of deployment of interventional techniques. Recommendations for conservative medical management are made based on the review of the medical management arms of the published interventional series. In addition, suggestions are made for practical modifications to the JNC 7 hypertension management protocol to better address the challenging diagnostic and management issues raised by the renovascular patient.
Covit
Andrew B
AB
UMDNJ-Robert Wood Johnson Medical School, Division of Nephrology and Hypertension, New Brunswick, New Jersey 08882, USA. acovit@nephrohibp.com
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D006978:Hypertension, Renovascular / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D018579:Patient Selection; D012078:Renal Artery Obstruction / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
D000959:Antihypertensive Agents