Role of Balloon Dilatation in the Treatment of Renovascular Hypertension

Abstract

Renal angioplasty is now well established as a treatment for renovascular hypertension. In patients with fibromuscular dysplasia, the technique is usually technically successful, and the therapeutic effect on blood pressure is as good as with surgical revascularization. In patients with atheroma, the success rate is lower, mainly because of technical problems associated with inability to pass the catheter across the stenosis. In patients in whom this can be done, the results are similar to those of surgery. In our experience, the rate of restenosis is acceptably low, and in most patients, improvement has been maintained over two years. Selection of suitable patients is based on screening from the clinical history and examination, combined with renin-sodium profiling. Renal vein renin measurements have been found reliably to predict the therapeutic outcome of angioplasty, and the incremental method of Vaughan has been preferable to use of the ratio between the two renal veins. In patients with high renin-sodium profiles or in those with normal profiles and a clinical suspicion of renovascular hypertension, renal vein renin values would be determined next, usually with digital intravenous angioplasty. A single test dose of captopril may also be useful as a screening test. If these procedures do indicate the presence of renovascular hypertension, the patient is admitted to the hospital, and arteriography and angioplasty are performed at the same session.