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Renovascular Hypertension Treatment

Renovascular hypertension results from stenosis of one or both renal arteries. Treatment of renovascular hypertension is targeted towards the medical correction of the resulting hypertension and anatomic repair of the stenosis.

The obvious goal of treatment of renovascular hypertension is control of blood pressure and prevention of the long-term sequelae of poorly controlled hypertension, including renal and cardiac failure. With the advent of medicines such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) control of blood pressure can almost uniformly be maintained. However, because these medications can alter renal blood flow and function, close monitoring of overall renal function is very important. If control of blood pressure sacrifices renal function, direct renal artery intervention may be warranted.

The contribution of lifestyle changes should not be underestimated. This includes weight loss, exercise, and dietary adjustments. Most important is the cessation of smoking cessation. These habits add to the effects of hypertension in causing complications.

The advent and rapid expansion of percutaneous interventional techniques has made these treatment methods very attractive in many cases. Balloon angioplasty and stenting is particularly advantageous in renal artery lesions of non-ostial, atherosclerotic origin and for FMD. During this procedure, a small needle puncture is made in the femoral artery in the groin and a catheter is advanced into the renal artery. Through this catheter, a small balloon or stent can be placed in the renal artery to correct the stenosis. This procedure is done in the angiographic suite with light sedation and requires one night stay in the hospital.

The success of angioplasty and stenting in treating renovascular hypertension has been very good. However, long-term follow up with renal ultrasound is necessary to identify any restenosis, which can occur at a moderate rate. When detected, these lesions may require repeat angioplasty if the patient's clinical scenario suggests recurrent renovascular hypertension. Occasionally, surgical reconstruction or bypass is required to relieve a renal artery stenosis and improve renovascular hypertension.

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Occasionally, surgical reconstruction or bypass is required to relieve a renal artery stenosis and improve renovascular hypertension.  The most frequent indications for surgery are:  multiple, failed renal angioplasty procedures; bilateral ostial atherosclerotic disease; and obstruction in the renal artery branches.  Surgical bypass results are excellent for endpoints such as graft patency, renal function preservation, and control of hypertension.  Complications during surgery are quite low, but it does involve a prolonged stay in the hospital and a recovery period of 2-3 months. Given the fact that the renovascular patient population is typically of advanced age with multiple comorbid medical conditions, their risk of perioperative mortality is not insignificant. For these reasons surgery is generally reserved for complex cases not amenable to percutaneous intervention.

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