Renovascular hypertension: an update.
Renovascular hypertension, the most common remediable cause of elevated blood pressure, is a controversial topic, but most authorities agree on several principles. The absolute risk of renovascular hypertension for a specific patient can be estimated using only clinical information, thereby sparing many patients further expensive and potentially dangerous evaluations. Patients with a high absolute risk of renovascular hypertension should have angiography only if they are willing to undergo revascularization if warranted. A screening test (captopril renography, Doppler ultrasonography, magnetic resonance angiography, or computed tomography) is recommended for those with an intermediate absolute risk. Angioplasty should be offered to patients with fibromuscular dysplasia. Whether intensive medical therapy (including an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker) for atherosclerotic renovascular hypertension is improved by angioplasty plus stent placement may be answered by ongoing studies, the largest of which may be the National Institutes of Health-funded Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial.
Elliott
William J
WJ
Department of Preventive Medicine, Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA. welliott@rush.edu
D000800:Angioplasty, Balloon; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents