Surgical treatment of renovascular hypertension.

Unilateral stenosis of the renal artery was verified by angiography in 34 patients with hypertension. The cause-effect relationship between elevated blood pressure and stenosis of the renal artery was proved by detailed renin studies (basic plasma renin activity, plasma renin activity following orthostatic and diuretic stimulation, renal vein renin activity). Surgical treatment was applied in 39 cases: they were aortorenal bypass in 9, autotransplantation in 7, patch graft in 2, denervation in 2, decompression in 3 and nephrectomy in 16 cases. Six months following the operation, 68.4% of the patients were normotensive without drugs and 18.4% of them with a reduced dose of drugs. To achieve normotension preoperative treatment had to be continued only in 13.2% of the patients. Two to four years postoperatively, 29 patients were subjected to control examinations and in 23 cases also to angiography. Restenosis was observed in 4 patients (17.4%). As a result of surgical treatment, the increased response to hyperreninaemia and to various stimuli decreased. Based on the control examinations, 58.7% of the patients could be considered to be cured.