Is "improvement" real with percutaneous transluminal angioplasty in the management of renovascular hypertension?

58 hypertensive patients with suspected renovascular disease underwent renal arteriography, and 29 (52%) were found to have renovascular disease. Percutaneous transluminal angioplasty was technically successful in 14 (50%) of the 29. The effect on blood pressure was assessed over 20 months. Technically successful transluminal angioplasty led to cure of hypertension in 4 patients (29%) and "improvement" in 5 (36%). However, "improvement" occurred spontaneously in 8 (32%) of the 25 patients found on arteriography not to have renovascular disease and who received no intervention. This suggests that reported improvement after transluminal angioplasty may be spurious and that the true benefit of the procedure can be assessed only from the cure rate. About 50% of patients with fibromuscular renovascular disease are cured of their hypertension but only about 8% of patients with atherosclerotic renovascular disease benefit from the procedure.