Clinical evaluation of renovascular hypertension and therapeutic decisions.

The renal arteriogram alone, useful as an anatomic guide for the surgeon or radiologist, is inadequate to predict potential blood pressure reversal by correction of the obstructing lesion. A patient must be identified as having functionally significant renal arterial disease before intervention can be recommended. The authors discuss uncovering functionally significant renal artery stenosis, the pathophysiology of experimental Goldblatt hypertension, and criteria to identify renovascular hypertension, including peripheral plasma renin activity and differential renal-vein renin determinations.