Conservative treatment of renovascular hypertension

Abstract

Enthusiasm for surgical treatment of hypertension followed the demonstration that nephrectomy or arterial reconstructive procedures can cure hypertension associated with occlusive renal arterial disease. Experience has tempered this enthusiasm for several reasons. Surgical treatment carries a high risk of myocardial infarction and strokes in patients with renal atherosclerosis and associated coronary and cerebral vascular disease. Also, the nonatherosclerotic renal arterial diseases can affect such long segments of the main artery and primary branches that reconstructive operations are not feasible; when the stenosis is unilateral, nephrectomy can be performed, but these lesions often occur bilaterally, requiring some type of revascularization operation. Further, there are some patients in whom either the hypertension or the occlusive disease is so mild that operative treatment does not seem warranted until one or the other worsens. Finally, there is as yet no sure way of determining whether the stenosis plays an important role in a patient’s hypertension, and, until a method is available, recommendation for surgical treatment must be based on clinical judgement alone.