Renovascular hypertension in 2007: where are we now?
Hypertension in patients with renovascular disease poses a major clinical challenge. Renal arterial disease accelerates hypertension by activation of multiple pressor systems. Although younger individuals with fibromuscular lesions often respond well to angioplasty with minor associated risks, care must be taken in cases of complex vascular anomalies, such as renal artery aneurysms. More than 85% of patients referred for revascularization have atherosclerotic renal artery stenosis; most are older patients with preexisting hypertension, diabetes, and vascular disease. The benefits of stent revascularization in this group are controversial. Antihypertensive therapy works best with drugs that block the renin-angiotensin system; however, most patients require multiple agents. Detailed analysis of the literature and small prospective trials failed to identify major benefits with renal artery angioplasty as compared with intensive drug therapy. The CORAL study and others seek to randomly assign subjects with high-grade renovascular lesions to optimal medical management with and without stenting.
Textor
Stephen C
SC
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. textor.stephen@mayo.edu
D000959:Antihypertensive Agents / Q000627:therapeutic use; D005352:Fibromuscular Dysplasia; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D012078:Renal Artery Obstruction / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D015607:Stents
D000959:Antihypertensive Agents