Renovascular Hypertension: Novel Insights

Author(s): Chrysoula Boutari, Eleni Georgianou, Alexandros Sachinidis, Alexandra Katsimardou, Konstantinos Christou, Alexia Piperidou, Asterios Karagiannis*

Journal Name: Current Hypertension Reviews

Volume 16 , Issue 1 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Renovascular hypertension (RVH) remains among the most prevalent and important, but also potentially reversible, causes of secondary hypertension. The predominant causes of renal artery stenosis (RAS) are atherosclerotic renovascular arterial stenosis (ARAS) and renal fibromuscular dysplasia. This condition can lead to progressive renal injury, cardiovascular complications and ‘flash pulmonary edema’. Duplex Doppler ultrasonography, computed tomographic angiography and magnetic resonance angiography are the most commonly used diagnostic methods. There are three therapeutic options available: medical therapy including renin-angiotensin-aldosterone system antagonists, lipid-lowering agents, and antiplatelet therapy, percutaneous angioplasty with or without stent placement and surgical revascularization. Three large trials failed to demonstrate the superiority of renal artery revascularization over pharmaceutical therapy in controlling blood pressure and preserving renal function. For this reason, today revascularization is only recommended for patients with progressive worsening of renal function, recurrent ‘flash pulmonary edema’ and rapid increase in antihypertensive requirement in patients with previously well-controlled hypertension. However, more properly designed trials are needed in order to identify which patient populations would probably benefit from renal revascularization.

Keywords: Renovascular hypertension, renal artery stenosis, revascularization, angioplasty, atherosclerosis, fibromuscular dysplasia.

[1]
Basso N, Terragno NA. History about the discovery of the renin-angiotensin system. Hypertension 2001; 38: 1246-9.
[2]
Persu A, Giavarini A, Touzé E, et al. ESH working group hypertension and the kidney. European consensus on the diagnosis and management of fibromuscular dysplasia. Hypertension 2014; 32: 1367-78.
[3]
Elliott WJ. Renovascular hypertension: An update. J Clin Hypertens 2008; 10: 522-33.
[4]
De Mast Q, Beutler JJ. The prevalence of atherosclerotic renal artery stenosis in risk groups: A systematic literature review. J Hypertens 2009; 27: 1333-40.
[5]
Horwitz EJ, Rahman M. Renovascular disease. In: Lerma EV, Sparks MA, Topf JM. . Nephrology secrets. Philadelphia, PA: Elsevier 2019; pp. 444-8.
[6]
Textor SC, Misra S, Oderich G. Percutaneous revascularization for ischemic nephropathy: The past, present and future. Kidney Int 2013; 83: 28-40.
[7]
Persu A, Van der Niepen P, Touzé E, et al. Revisiting fibromuscular dysplasia: Rationale of the European fibromuscular dysplasia initiative. Hypertension 2016; 68: 832-9.
[8]
Rossignol P, Chatellier G, Azizi M, et al. Proteinuria in renal artery occlusion is related to active renin concentration and contralateral kidney size. J Hypertens 2002; 20: 139-44.
[9]
Zamboulis C, Karagiannis A, Douma S, et al. Changes of plasma noradrenaline levels in the renal and systemic circulation after successful percutaneous transluminal angioplasty in renovascular hypertension. Clin Exp Hypertens A 1989; 11(Suppl. 1): 449-58.
[10]
Textor SC, Lerman L. Renovascular hypertension and ischemic nephropathy. Am J Hypertens 2010; 23: 1159.
[11]
Tafur JD, White CJ. Renal artery stenosis: When to revascularize in 2017. Curr Probl Cardiol 2017; 42: 110-35.
[12]
Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021-104.
[13]
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71(6): e13-e115.
[14]
Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 113e463
[15]
Textor S. Establishing the diagnosis of renovascular hypertension Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.. http://www.uptodate.com (Accessed on September, 2018).
[16]
Postma CT, Joosten FB, Rosenbusch G, et al. Magnetic resonance angiography has a high reliability in the detection of renal artery stenosis. Am J Hypertens 1997; 10: 957.
[17]
Lao D, Parasher PS, Cho KC, Yeghiazarians Y. Atherosclerotic renal artery stenosis-diagnosis and treatment. Mayo Clin Proc 2011; 86: 649-57.
[18]
Chrysochou C, Foley RN, Young JF, et al. Dispelling the myth: The use of renin-angiotensin blockade in atheromatous renovascular disease. Nephrol Dial Transplant 2012; 27: 1403-9.
[19]
Tullis MJ, Caps MT, Zierler RE, et al. Blood pressure, antihypertensive medication, and atherosclerotic renal artery stenosis. Am J Kidney Dis 1999; 33: 675.
[20]
Dworkin LD, Cooper CJ. Clinical practice. Renal-artery stenosis. N Engl J Med 2009; 361: 1972-8.
[21]
Murphy TP, Soares G, Kim M. Increase in utilization of percutaneous renal artery interventions by medicare beneficiaries, 1996-2000. AJR Am J Roentgenol 2004; 183: 561-8.
[22]
Stanley JC, David M. Hume memorial lecture. Surgical treatment of renovascular hypertension. Am J Surg 1997; 174: 102.
[23]
Novick AC. Long-term results of surgical revascularization for renal artery disease. Urol Clin North Am 2001; 28: 827.
[24]
Abela R, Ivanova S, Lidder S, et al. An analysis comparing open surgical and endovascular treatment of atherosclerotic renal artery stenosis. Eur J Vasc Endovasc Surg 2009; 38: 666-75.
[25]
Bax L, Mali WP, Van De Ven PJ, et al. Repeated intervention for in-stent restenosis of the renal arteries. J Vasc Interv Radiol 2002; 13: 1219-24.
[26]
Martin LG, Rees CR, O’Bryant T. Percutaneous angioplasty of the renal arteries. In: Strandness DE Jr, van Breda A, eds. . Vascular diseases: Surgical & interventional therapy. 3rd ed. New York: Churchill Livingstone 1994; pp. 721-41.
[27]
Kidney D, Deutsch LS. The indications and results of percutaneous transluminal angioplasty and stenting in renal artery stenosis. Semin Vasc Surg 1996; 9: 188-97.
[28]
Tegtmeyer CJ, Elson J, Glass TA, et al. Percutaneous transluminal angioplasty: the treatment of choice for renovascular hypertension due to fibromuscular dysplasia. Radiology 1982; 143: 631-7.
[29]
Sos TA, Pickering TG, Saddekni S, et al. The current role of renal angioplasty in the treatment of renovascular hypertension. Urol Clin North Am 1984; 11: 503-13.
[30]
Gray BH, Olin JW, Childs MB, et al. Clinical benefit of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure. Vasc Med 2002; 7: 275-9.
[31]
Boateng FK, Greco BA. Renal artery stenosis: prevalence of, risk factors for, and management of in-stent stenosis. Am J Kidney Dis 2013; 61: 147-60.
[32]
Bonelli FS, McKusick MA, Textor SC, et al. Renal artery angioplasty: Technical results and clinical outcome in 320 patients. Mayo Clin Proc 1995; 70: 1041.
[33]
van Brussel PM, van de Hoef TP, de Winter RJ, et al. Hemodynamic measurements for the selection of patients with renal artery stenosis: A systematic review. JACC Cardiovasc Interv 2017; 10: 973.
[34]
Beck AW, Nolan BW, De Martino R, et al. Predicting blood pressure response after renal artery stenting. J Vasc Surg 2010; 51: 380.
[35]
Tuttle KR, Chouinard RF, Webber JT, et al. Treatment of atherosclerotic ostial renal artery stenosis with the intravascular stent. Am J Kidney Dis 1998; 32: 611.
[36]
Trinquart L, Mounier-Vehier C, Sapoval M, et al. Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: A systematic review and meta-analysis. Hypertension 2010; 56: 525.
[37]
van de Ven PJ, Kaatee R, Beutler JJ, et al. Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: A randomised trial. Lancet 1999; 353: 282.
[38]
Blum U, Krumme B, Flügel P, et al. Treatment of ostial renal-artery stenoses with vascular endoprostheses after unsuccessful balloon angioplasty. N Engl J Med 1997; 336: 459.
[39]
Rocha-Singh K, Jaff MR, Rosenfield K. ASPIRE-2 Trial Investigators. Evaluation of the safety and effectiveness of renal artery stenting after unsuccessful balloon angioplasty: The ASPIRE-2 study. J Am Coll Cardiol 2005; 46: 776.
[40]
van de Ven PJ, Beutler JJ, Kaatee R, et al. Transluminal vascular stent for ostial atherosclerotic renal artery stenosis. Lancet 1995; 346: 672.
[41]
Rees CR, Palmaz JC, Becker GJ, et al. Palmaz stent in atherosclerotic stenoses involving the ostia of the renal arteries: Preliminary report of a multicenter study. Radiology 1991; 181: 507.
[42]
Zeller T, Frank U, Müller C, et al. Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis. Circulation 2003; 108: 2244.
[43]
Plouin PF, Chatellier G, Darné B, et al. Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: A randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group. Hypertension 1998; 31: 823-9.
[44]
Webster J, Marshall F, Abdalla M, et al. Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group. J Hum Hypertens 1998; 12: 329-35.
[45]
van Jaarsveld B, Krijnen P, Bartelink A, et al. The Dutch Renal Artery Stenosis Intervention Cooperative (DRASTIC) study: Rationale, design and inclusion data. J Hypertens Suppl 1998; 16: S21-7.
[46]
Ives NJ, Wheatley K, Stowe RL, et al. Continuing uncertainty about the value of percutaneous revascularization in atherosclerotic renovascular disease: A meta-analysis of randomized trials. Nephrol Dial Transplant 2003; 18: 298-304.
[47]
ASTRAL Investigators, Wheatley K, Ives N, Gray R, et al. . Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009; 361: 1953-62.
[48]
Cooper CJ, Murphy TP, Cutlip DE, et al. CORAL Investigators. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 2014; 370: 13-22.
[49]
Bax L, Woittiez AJ, Kouwenberg HJ, et al. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: A randomized trial. Ann Intern Med 2009; 150: 840-8.
[50]
May AG, De Weese JA, Rob CG. Hemodynamic effects of arterial stenosis. Surgery 1963; 53: 513-24.
[51]
Anderson JL, Halperin JL, Albert A, et al. Management of Patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations). J Am Coll Cardiol 2013; 61: 1555-70.
[52]
Muray S, Martín M, Amoedo ML, et al. Rapid decline in renal function reflects reversibility and predicts the outcome after angioplasty in renal artery stenosis. Am J Kidney Dis 2002; 39: 60-6.
[53]
Kane GC, Xu N, Mistrik E, et al. Renal artery revascularization improves heart failure control in patients with atheroscleroticrenal artery stenosis. Nephrol Dial Transplant 2010; 25: 813-20.
[54]
Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: Diagnosis, evaluation, and treatment: A scientific statement from the American Heart Association professional education Committee of the Council for high blood pressure research. Circulation 2008; 117: e510-26.
[55]
Karagiannis A, Tziomalos K, Anagnostis P, et al. Atherosclerotic renal artery stenosis: Medical therapy alone or in combination with revascularization? Angiology 2009; 60: 397-402.
[56]
Azizi M. Renal artery stenting in patients with documented resistant hypertension and Atherosclerotic Renal Artery Stenosis (ANDORRA). ClinicalTrials.gov Identifier: NCT02539810..
[57]
Wang W, Saad A, Herrmann SM, et al. Changes in inflammatory biomarkers after renal revascularization in atherosclerotic renal artery stenosis. Nephrol Dial Transplant 2016; 31: 1437-43.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 1
Year: 2020
Page: [24 - 29]
Pages: 6
DOI: 10.2174/1573402115666190416153321

Article Metrics

PDF: 46
HTML: 2