XVII. Treatment of hypertension in association with renovascular disease

Prevention and Treatment

Recommendations

  1. Patients with hypertension attributable to atherosclerotic renal artery stenosis should be primarily medically managed because renal angioplasty and stenting offers no benefit over optimal medical therapy alone (Grade B).
  2. Renal artery angioplasty and stenting for atherosclerotic hemodynamically significant renal artery stenosis could be considered for patients with any of the following (Grade D; revised recommendation):

    1. Uncontrolled hypertension resistant to maximally tolerated pharmacotherapy,
    2. Progressive renal function loss,
    3. Acute pulmonary edema.
  3. Patients with confirmed renal FMD should be referred to a hypertension specialist (Grade D).
  4. Renal artery angioplasty without stenting is recommended for treatment of FMD-related renal artery stenosis. Stenting is not recommended unless needed because of a periprocedural dissection. Surgical revascularization should be considered in case of complex lesions less amendable to angioplasty, stenosis associated with complex aneurysm, and restenosis despite 2 unsuccessful attempts of angioplasty (Grade D)