What is the prognosis of renovascular hypertension (RVHT)?

Updated: Dec 01, 2020
  • Author: Rebecca J Schmidt, DO, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The prognosis of patients with RVHT is difficult to ascertain and varies with the extent of the occlusive phenomena, the sensitivity of the individual to antihypertensive therapy, and the efficacy of surgical repair or angioplasty. In patients with hypertension, the presence of atherosclerotic renal artery disease is a strong predictor of increased mortality relative to the general population. RVHT in the setting of renal dysfunction is associated with the greatest mortality.

Although the actual mortality of untreated RVHT is not clear, the prognosis is clearly poor, and the severity of the hypertension places considerable amount of strain on target organs and can lead to death. Fortunately, renovascular disease may be correctable with surgical treatment or invasive intervention.

A retrospective review of a cohort that included 30 severely hypertensive children with renovascular disease found an overall 18% incidence of hypertensive retinopathy. Most of the children had severe disease (retinal hemorrhages, exudates, and optic disc edema) and in some cases permanent visual reduction. [16]

PTRA yields normal blood pressures in some patients and others experience a decrease in blood pressures. Unfortunately, a high rate of recurrence of hypertension and vascular stenosis appears to be observed in patients treated with PTRA. [17] Some patients may experience resolution of their hypertension after nephrectomy.

Revascularization using PTRA with or without stenting in combination with medical therapy has been investigated in randomized trials of patients with unilateral atherosclerotic renal artery stenosis.  A meta-analysis of these trials found no benefit from PTRA on mortality or end-stage renal disease as major cardiovascular events. [18]

Patients who have a high likelihood of benefit from revascularization with PTRA with stenting and medical therapy versus medical therapy alone are those that have unilateral renal artery stenosis, bilateral renal artery stenosis, or stenosis of a solitary kidney and meet one or more of the following criteria [12] :

  1. Recurrent congestive heart failure or sudden unexplained pulmonary edema
  2. Unstable angina
  3. Accelerated, resistant, or malignant hypertension
  4. Hypertension with unexplained unilateral small kidney and intolerance to medication

Successful surgical intervention is expected to offer patients a normal lifespan without complications. Children who undergo surgical revascularization appear to do well for at least 16 years postoperatively. They are able to participate in active sports and similar vigorous activities without problems. Further long-term follow-up is needed to determine the durability of these reconstructions and the actual life potential of these children.


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