Hypertension and renal artery stenosis: Serial observations on 54 patients treated medically

Medical treatment of hypertension was undertaken in 54 selected patients with arteriographically proved stenosis of the renal artery (32 with atheromatous and 22 with fibromuscular lesions). At follow‐up study (average, 20.3 months), 65 per cent of 49 surviving patients were normotensive on a regimen of common antihypertensive drugs in usual doses. There also was improvement in the hypertensive changes noted in the optic fundus. In 13 patients, additional cardiovascular episodes complicated the hypertensive disease and 5 of these patients had died. The frequent long duration of hypertension and frequent bilateral involvement of the renal arteries necessitate caution in recommending surgical treatment when: (1) the situation technically demands nephrectomy; (2) there are renovascular lesions in the absence of significant hypertension; (3) arteriographic and renal function data are discordant; and (4) there is associated severe symptomatic cardiovascular disease, old age, or other infirmities.