Patient Indications

• Considerations that favor a decision of medical therapy include:
  • Mild hypertension
  • Old age with severe associated cardiac, cerebrovascular, or aortic disease
  • The presence of adequate blood pressure control with good renal function that remains stable

Methods of Medical Control

• Control of dietary sodium and weight loss are important parts of hypertension control.
• Diuretics
• Other antihypertensive agents (added if the diastolic blood pressure remains above 100 mm Hg)
• Multiple drug regimens including beta-blockers, calcium channel blockers, vasodilators, and, rarely, ganglionic blocking agents (use of ganglionic blocking agents, although sometimes effective, usually prompts therapeutic intervention in the absence of extreme contraindications)
• Angiotensin inhibitor (Captopril)

References

Calligaro P, Modern Management of Renovascular Hypertension and Renal Salvage, Williams & Wilkins, 1996.

Dean RH, Krueger TC, Whiteneck JM, et al: Operative management of renovascular hypertension: Results after a follow-up of fifteen to twenty-three years. J Vasc Surg 1:234-422, 1984.

Galanski M, Prokop M, Chavan A, et al: Renal artery stenosis: Sprial CT angiography. Radiology 189:185-192, 1993.

Martin LG, Price RB, Casarella WJ, et al: Percutaneous angioplasty in the clinical management of renovascular hypertension: Initial and long term results. Radiology 155:629, 1985.

Meier GH, Sumpio B, Black HR, Gusberg RJ; Captopril renal scintography. An advance in the detection and treatment of renovascular hypertension. J Vasc Surg 11:770-777, 1990.

Prince MR, Narasimham DL, Stanley JC, et al: Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. Radiology 197:785, 1995.

Raynaud AC, Beyssen BM, Turmel-Rodrigues LE, et al. Renal artery stent placement: Immediate and midterm technical and clinical results. JVIR 5:849, 1994.

Strandnesss DE. Duplex scanning in diagnosis of renovascular hypertension. Surg Clin North Am 70:109-117, 1990.

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