Revascularization in Resistant Hypertension Due to Renal Artery Stenosis

Abstract

Background: Renal artery stenosis (RAS) is a significant cause of resistant hypertension, especially in patients presenting with comorbidities. Revascularization has been initially recommended to treat resistant hypertension due to RAS. However, recent studies have shown modest benefits for blood pressure control over medical therapy only. There is limited data on revascularization in patients with resistant hypertension and RAS, particularly in patients with a high cardiovascular risk profile. Materials and Methods: A systematic review of case reports was conducted to summarize the outcomes of revascularization in patients with resistant hypertension and RAS. The search was conducted through the Medline database (2013–2023) and was able to identify nine relevant reports documenting ten cases. Data on patient characteristics, blood pressure (BP), renal function, and antihypertensive medications before and after revascularization were extracted and analyzed descriptively. Results: The average age of patients was 60.4 years, with an equal distribution of male and female cases. Following revascularization, systolic BP decreased from 170 mmHg (± 29.69) to 126 mmHg (± 3.53), and diastolic BP from 96 mmHg (± 16.97) to 74 mmHg (± 7.07). The average number of antihypertensive medications reduced from four to two. Renal function also improved in all cases where creatinine and eGFR data were reported. Conclusions: Revascularization in RAS showed its benefit in lowering BP and medication burden, along with improving renal function in select cases. Decision for revascularization should be tailored to each patient while considering its potential risks and benefits.

Keywords

• renal artery stenosis
• resistant hypertension
• revascularization
• blood pressure