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Fibromuscular dysplasia: catheter, cut or laissez faire? That remains the question

Journal of Human Hypertension volume 19, pages 755–756 (2005)Cite this article

Fibromuscular dysplasia can result in significant hypertension in women between 15 and 50 years of age. It, however, only accounts for <10% of cases of renovascular hypertension. While fibromuscular dysplasia has been shown to affect multiple arterial beds, the frequency of involvement in renal arteries is 60–70%, with bilateral disease occurring in 35% of patients.

The natural history of renal fibromuscular dysplasia is progression in up to 37% of patients.1 Renal artery fibromuscular dysplasia only rarely progresses to complete occlusion of the renal artery. Patients with fibromuscular dysplasia do demonstrate a significant decrease in mean cortical thickness and reduced renal length compared to comparable patients with essential hypertension. While up to 63% of patients with fibromuscular dysplasia experience a loss of renal mass, the incidence of renal failure remains remarkably low.1, 2 Thus, the main impetus for treatment of fibromuscular dysplasia is control of hypertension and its attendant complications. These patients should be primarily managed medically and pharmacologic therapy for hypertension should follow the guidelines set forth for the prevention, detection and evaluation of treatment of high blood pressure. Revascularization should be reserved for those patients who have recent onset of hypertension with the primary goal to cure the hypertension and those in whom blood pressure control has proved difficult to achieve using a comprehensive antihypertensive regimen and those intolerant of antihypertensive therapy and those who are not compliant with their antihypertensive medication or have demonstrated a loss of renal volume leading to a diagnosis of ischemic nephropathy.3

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  1. Division of Vascular Surgery, Center for Vascular Disease, University of Rochester, Rochester, NY, USA

    M G Davies & D L Waldman

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  1. M G Davies
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  2. D L Waldman
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Correspondence to M G Davies.

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Davies, M., Waldman, D. Fibromuscular dysplasia: catheter, cut or laissez faire? That remains the question. J Hum Hypertens 19, 755–756 (2005). https://doi.org/10.1038/sj.jhh.1001932

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