LETTER
Screening for Renovascular Hypertension
David G. Martinez
1 June 1993 | Volume 118 Issue 11 | Pages 905-906
TO THE EDITOR:
Mann and Pickering [1] correctly recommend screening for renovascular hypertension only in patients with a moderate or high suspicion of the disease [1]. Other determining factors for screening, however, include the patient's willingness to have treatment if renovascular disease is found and the physician's willingness to pursue treatment based on the patient's risk profile and ease of hypertension control.
In the best of hands, surgical mortality for repair of atheromatous renovascular disease is 2% [2] and may approach 9.3% [3]. Many of these patients have coronary artery disease or peripheral vascular disease, use tobacco, or have chronic obstructive pulmonary disease, which may further increase surgical risk. Furthermore, up to one third of patients with hypertension from atheromatous renovascular disease exhibit no improvement in control from surgical repair [3]. High-risk patients can often have their hypertension controlled with minoxidil and a diuretic.
Treatment options and expectations need to be discussed carefully with the patient. If medical therapy is selected, screening need not be done.
1. Mann SJ, Pickering TG. Detection of renovascular hypertension. State of the art: 1992. Ann Intern Med. 1992; 117:845-53.
2. Novick AC, Ziegelbaum M, Vidt DG. Trends in surgical revascularization for renal artery disease: ten years' experience. JAMA. 1987; 257:498-501.
3. Foster JH, Dean RH, Pinkerton JA, Rhamy RK. Ten years' experience with the surgical management of renovascular hypertension. Ann Surg. 1973; 177:755-66.
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