Surgical treatment of renovascular hypertension caused by arteriosclerosis. II. Influence of preoperative risk factors and postoperative blood pressure response on late patient survival.

This study assesses the late survival of 103 patients with renovascular hypertension caused by arteriosclerosis who underwent reconstructive surgery during the period of 1959 through 1982. It provides a detailed analysis of the influence of preoperative factors and the postoperative blood pressure response to fatal and nonfatal cardiovascular events during follow-up. All patients suffered from severe hypertension. Arteriosclerosis was limited to the renal arteries in 52% of the patients, while 48% showed overt extrarenal arteriosclerosis. Hypertensive target organ damage was present in 68% of the patients. At a mean of 8.5 months postoperatively, 80% of the patients showed beneficial and 20% showed unsatisfactory blood pressure responses. These results were not related to the presence or absence of extrarenal arteriosclerosis. Overall, late (10 years) patient survival was significantly lower than the expected survival of a reference population (79% versus 92%; p less than 0.0001). Late patient survival was not influenced by the absence or presence of extrarenal arteriosclerosis (82% versus 82%) or target organ damage (83% versus 82%), but late survival was significantly better with beneficial (87%) than with unsatisfactory blood pressure responses (67%). This effect was especially conspicuous in the presence of extrarenal arteriosclerosis (88% versus 57%; p = 0.04) but not in its absence (86% versus 74%; p = 0.41). In terms of long-term survival, these findings clearly demonstrate the favorable effect of successful surgical treatment of patients with renovascular hypertension caused by arteriosclerosis. Moreover, they illustrate that the mere presence of preoperative extrarenal arteriosclerosis or target organ damage is not sufficient argument against surgical therapy.