MECHANISMS, DIAGNOSIS AND TREATMENT OF HYPERTENSION OF RENAL VASCULAR ORIGIN

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Abstract
Good evidence now supports the notion that renal hypertension is initiated by a change in the character of the pulse waves in the renal arteries followed by liberation of renin and production of angiotensin. In selected patients something of the order of 25 to 30% will be found to have renal artery lesions as shown by retrograde pyelography, split function tests and aortograms. The composition of the urine is determined by the renal lesion rather than by the cause of the hypertension. Renal hypertension is usually of moderate severity and may occur in the very young and in the age group where atherosclerosis is common. Fifty-nine patients have been operated upon with the result that 31 became normotensive, 7 still have systolic hypertension, 7 had moderate blood pressure reduction and 9 were unchanged. Five deaths occurred which were closely associated with operation and 6 died later from progressive vascular disease. The medical treatment of renal hypertension must be weighed against the surgical, and indications are given which will help in this decision.