Consensus on renovascular hypertension: diagnosis and treatment

Abstract

The clinical significance of renovascular arterial hypertension is determined by it is high prevalence as well as it is negative impact on prognosis. The most common causes of renovascular arterial hypertension are atherosclerotic stenosis of the renal arteries and fibromuscular dysplasia. Renovascular arterial hypertension is characterized by the development of blood pressure resistant to antihypertensive therapy with an unfavorable prognosis of worsening renal function and cardiovascular complications. Currently, the most available screening method in the diagnosis of renovascular arterial hypertension is duplex scanning of the renal arteries. Non-invasive diagnostic methods also include magnetic resonance and multispiral computed tomography with intravenous contrast. Contrast angiography remains “the golden standard” for diagnosing renovascular arterial hypertension and determining the indications for surgical treatment. Together with the use of diagnostic techniques such as measurement of translesion pressure gradient and fractional blood flow reserve, it allows to assess the functional significance of renal artery stenosis. Treatment of renovascular arterial hypertension is a complex process aimed at normalization of blood pressure, improvement of renal function, as well as mortality and cardiovascular risk reduction. To date, the feasibility of endovascular treatment remains an open question. More often the preference is given to conservative treatment. The indications for renal artery revascularization are less obvious, available clinical guidelines and results of large trials are controversial.