|Renovascular hypertension is treated with drugs, surgical revascularization, or angioplasty. In both surgical revascularization and angioplasty, adequate blood supply to the affected kidney is restored. The type of treatment selected depends on the cause of the hypertension and the individual's risk factors regarding surgery. Generally, however, returning adequate blood supply by revascularization or angioplasty is preferred to medication.|
Surgical revascularization involves removing the narrowed portion of artery and replacing it with a healthy section of a blood vessel removed from another body site. Angioplasty involves the insertion of a catheter into the affected renal artery. On the end of the catheter is a deflated balloon. When the catheter reaches the narrowed portion of the artery, the balloon is inflated. This action opens up the artery. A hollow tube called a stent is usually inserted into the widened artery to help keep it open.
Advanced kidney disease due to low oxygen supply (ischemic nephropathy) is treated either with surgical revascularization or angioplasty.
Renovascular hypertension caused by atherosclerosis is less effectively treated by surgical revascularization or angioplasty, because such individuals may have hypertension unrelated to renovascular disease (essential hypertension). In such cases, atherosclerosis present in other vessels may likely return to the renal arteries. Similarly, clumps (emboli) of cholesterol may be released during the surgery and may subsequently block a vessel.
Individuals with atherosclerosis and those who are poor candidates for revascularization or angioplasty receive ongoing drug therapy using angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers. Smokers are advised to quit.
Long-term drug therapy is used for individuals who are not good candidates for surgery or angioplasty. Renovascular hypertension, however, is difficult to control with drug therapy. In some individuals, kidney function continues to decline in spite of drug therapy. ACE inhibitors also may cause a deterioration in kidney function. Individuals taking an ACE inhibitor should be monitored closely.
Source: Medical Disability Advisor