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Review
. 2020 Nov;35(6):627-635.
doi: 10.1097/HCO.0000000000000790.

Management of renovascular hypertension

Stephen C Textor  1
Affiliations
Review

Management of renovascular hypertension

Stephen C Textor. Curr Opin Cardiol. 2020 Nov.

Abstract

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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References

    1. Herrmann SM, Textor SC. Current concepts in the treatment of renovascular hypertension. Am J Hypertens 2018; 31:139–149.
    1. Textor SC, Taler SJ. Rediscovering renovascular hypertension. Hypertension 2019; 74:1297–1299.
    1. White CJ. Open renal arteries are better than closed renal arteries. Catheterization Cardiovasc Diagn 1998; 45:9–10.
    1. Raman G, Adam GP, Halladay CW, et al. Comparative effectiveness of management strategies for renal artery stenosis: an updated systematic review. Ann Intern Med 2016; 165:635–649.
    1. Hackam DG, Duong-Hua ML, Mamdani M, et al. Angiotensin inhibition in renovascular disease: a population-based cohort study. Am Heart J 2008; 156:549–555.