Treatment options for renovascular hypertension

Expert Opinion on Pharmacotherapy
J David Spence

Abstract

Renovascular hypertension is usually caused by atherosclerotic narrowing of the origin of the renal artery and is much more common than is thought among patients with peripheral vascular disease, carotid stenosis or heart failure. Renovascular hypertension must be distinguished from renal artery stenosis. In true renovascular hypertension, the kidney takes charge of the blood pressure and will do what it takes to push blood pressure high enough to force blood through the blocked artery. This can be diagnosed with functional tests that measure glomerular filtration rate before and after blockade of the renin-angiotensin system with angiotensin converting enzyme inhibitors or antagonists of the AT(1) subtype of the angiotensin receptor. There is insufficient data on which to make evidence-based recommendations on the management of renovascular hypertension. Only two randomised trials exist of angioplasty versus medical therapy and of these the larger was severely contaminated by angioplasty among the group initially assigned to medical therapy. Only one trial exists of angiotensin converting enzyme inhibition versus alternative medical therapy. The drugs that are most effective in medical management of renovascular hypertension--...Continue Reading

References

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Citations

Aug 11, 2010·Nature Reviews. Neurology·J David Spence
Jan 22, 2011·Journal of Translational Medicine·José M López-NovoaFrancisco J López Hernández
Aug 19, 2007·Expert Opinion on Pharmacotherapy·J David Spence
Sep 2, 2008·American Heart Journal·Daniel G HackamAmit X Garg
Jun 27, 2018·Hypertension·J David Spence, Brian L Rayner
Jan 11, 2005·Journal of Drug Education·Johanna D BirckmayerKaren B Friend
Dec 7, 2019·BMJ Evidence-based Medicine·J David Spence
Sep 14, 2004·Journal of Hypertension·J David Spence

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