Surgical treatment of renovascular hypertension caused by arteriosclerosis. I. Influence of preoperative factors on blood pressure control early and late after reconstructive surgery.

This study evaluates the long-term efficacy of reconstructive surgery for renovascular hypertension caused by arteriosclerosis, which was performed on 112 patients from 1959 to 1983. Despite medical therapy, all patients had persistent hypertension, with a mean preoperative blood pressure of 188/113 mm Hg. Their median age was 49 years, and the median duration of objectively documented hypertension was 21 months at the time of surgery. Manifestations of extrarenal arteriosclerosis (ERA) were present in 57 patients (51%). Results were evaluated both at a short-term (ST) interval (mean: 8.4 months) and at a long-term (LT) interval (mean: 8.9 years) postoperatively. Patients were classified by means of strict criteria as cured, improved, or unsuccessfully treated. If a patient was cured or if his condition improved, this was considered a beneficial blood pressure response. Beneficial responses were maintained during LT follow-up, since the respective percentages for cure and improvement were 24% and 50% at the ST interval and 18% and 61% at the LT interval. These results had not been influenced by either older age or the presence of ERA, since results were similar in patients older and younger than the median age and in those with and without ERA. The preoperative duration of hypertension was the only pertinent clinical feature that influenced the LT interval results, LT beneficial responses were observed in 95% of the patients with a shorter duration and in 78% of those with a longer duration of preoperative hypertension than the median (p = 0.01). We conclude that surgical therapy for renovascular hypertension caused by arteriosclerosis can effectively reduce blood pressure and that this result is maintained during LT follow-up. In terms of anticipated blood pressure response, older age, longer duration of hypertension, and the presence of ERA do not exclude surgical therapy.