Renovascular hypertension: Review

Abstract

Hypertension, one of the risk factors for development of cardiovascular diseases, is classified as primary and secondary according to the mechanism of development. Secondary hypertension is the elevation of blood pressure, whose underlying cause can be defined and often be treatable. The most common cause of secondary hypertension is renovascular hypertension (RVHTN). RVHTN is defined as blood pressure elevation due to obstructive disease of one or two main renal arteries or their branches. The main reason of RVHTN is stenosis from atherosclerosis affecting main renal artery, and the most of the remaining cases are fibromuscular dysplasia. The former is mostly seen in men at an advanced age, the latter is especially seen in young women. If RVHTN is suspected after clinical evaluation, noninvasive diagnostic tests first must be done. If the non invasive test results are positive, renal arteriography must definitely be considered to confirm the diagnosis. The aim of therapy for RVHTN is to regulate blood pressure, prevent problems that are caused by ischemia due to renal artery stenosis, and reverse such problems. Severity of hypertension, etiology of RVHTN, the presence of renal function abnormalities, and the presence of comorbid conditions that affect the patient's survival are important in guiding treatment. Four treatment alternatives are under consideration for RVHTN cases: medical treatment, percutaneous transluminal renal angioplasty (PTRA), PTRA and stent placement, and surgical revascularization. Every outpatient clinic should make a treatment choice according to their experience and after careful consideration of the patient's risks and benefits from revascularization therapy. Copyright © 2012 by Türkiye Klinikleri.