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  • Review Article
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Review Series - Recent Advances in the Management of Secondary Hypertension

How should we define appropriate patients for percutaneous transluminal renal angioplasty treatment?

Hypertension Research volume 43, pages 1015–1027 (2020)Cite this article

Abstract

Renovascular hypertension (RVH) is one of the most common causes of secondary hypertension and can result in resistant hypertension. RVH is associated with an increased risk for progressive decline in renal function, cardiac destabilization syndromes including “flash” pulmonary edema, recurrent congestive heart failure, and cerebrocardiovascular disease. The most common cause of renal artery stenosis (RAS) is atherosclerotic lesions, followed by fibromuscular dysplasia. The endovascular technique of percutaneous transluminal renal angioplasty (PTRA) with or without stenting is one of the standard treatments for RAS. Randomized controlled trials comparing medical therapy with PTRA to medical therapy alone have failed to show a benefit of PTRA; however, the subjects of these randomized clinical trials were limited to atherosclerotic RAS patients, and patients with the most severe RAS, who would be more likely to benefit from PTRA, might not have been enrolled in these trials. This review compares international guidelines related to PTRA, reevaluates the effects of PTRA treatment on blood pressure and renal and cardiac function, discusses strategies for the management of RVH patients, and identifies factors that may predict which patients are most likely to benefit from PTRA.

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Acknowledgements

This work was supported by a Japan Society for the Promotion of Science (JSPS) Grant-in-Aid for Scientific Research (C), Number 17K09743.

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  1. Department of Nephrology and Hypertension, Dokkyo Medical University, Mibu, Tochigi, Japan

    Yoshio Iwashima & Toshihiko Ishimitsu

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Iwashima, Y., Ishimitsu, T. How should we define appropriate patients for percutaneous transluminal renal angioplasty treatment?. Hypertens Res 43, 1015–1027 (2020). https://doi.org/10.1038/s41440-020-0496-z

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