Key result
Antihypertensive drug therapy remains central for renovascular hypertension while revascularization targets high-risk resistant cases.
Why the study?
Renovascular occlusive disease remains a common cause of resistant and rapidly progressive hypertension, and current management practices and patient selection criteria require summarization and clarification.
Medical therapy remains the cornerstone for renovascular hypertension, with revascularization reserved for high-risk patients with refractory hypertension or flash pulmonary edema.
Reinforces medical-first strategy in renovascular hypertension; leaves open selective revascularization benefits in high-risk resistant cases for prospective trials.
PURPOSE OF REVIEW: Renovascular occlusive disease remains a common cause of resistant and rapidly progressive hypertension. The present review summarizes current practice regarding management of renovascular hypertension (RVH). RECENT FINDINGS: Current data using blood oxygen level dependent MR emphasize the tolerance of the kidney to moderate reductions in blood flow and the efficacy of antihypertensive drug therapy for many individuals. Prospective trials have failed to identify benefits of revascularization for moderate disease, either regarding blood pressure or renal function. Antihypertensive drug therapy including renin-angiotensin system blockade is central to management of RVH. Recent and ongoing observational studies report important improvements after revascularization regarding blood pressure, management of refractory or 'flash' pulmonary edema, and survival in specific 'high risk' clinical populations not included in randomized trials. Research directions underscore the role of adjunctive measures, including mitochondrial protection, therapeutic angiogenesis, and cell-based regenerative repair to protect kidney function in RVH. SUMMARY: Clinicians should recognize the potential for disease progression to threaten renal function with severe and prolonged renal ischemia. Improved patient selection for true resistant hypertension with RVH and 'high-risk' clinical manifestations is critical to identify those likely to benefit from renal revascularization.
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Stephen C. Textor (2020) conducted a review in Renovascular hypertension. Antihypertensive drug therapy and revascularization was evaluated. Antihypertensive drug therapy is central to managing renovascular hypertension, whereas revascularization may benefit specific high-risk populations with true resistant hypertension.
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