Reconstructive surgery for renovascular hypertension. II. Influence of patient selection and anatomical result on the blood pressure response after operation.

The results of renovascular surgery for renovascular hypertension are influenced markedly by patient selection. Our method of patient selection was based primarily on clinical characteristics rather than functional tests. To determine its effect on the results obtained by surgery, we studied all 115 patients in whom angiography showed that surgery had eliminated the renal artery stenosis. Six to 12 months after the operation, hypertension was cured or improved in 83 per cent of the patients and 17 per cent were classified as treatment failures. The results obtained for patients with stenosis caused by arteriosclerosis were similar to those found for patients with fibrodysplasia. Clinical characteristics (sex, blood pressure, duration of hypertension, creatinine level and extrarenal arteriosclerosis or target organ damage before surgery) were analysed separately. The characteristics of patients with a beneficial blood pressure response were not significantly different from those of patients who failed to respond, except for the blood pressure level itself. On the basis of our findings and the results of functional tests reported in the literature, we conclude that the decision to operate should be based on all of the clinical data available. Functional tests can be used to support the diagnosis of renovascular hypertension in selected patients. The presence of extrarenal arteriosclerosis before surgery is not associated with a poorer chance of a beneficial blood pressure response.