Predictive value of angiotensin II antagonists in renovascular hypertension

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Abstract
An angiotensin II antagonist, sarcosine-1, threonine-8 angiotensin II ([Sar1, Thr8]A II), was infused preoperatively in 14 patients with renal artery stenosis. Postoperative graft patency was documented by renal flow scan in 13 patients. One of these required antihypertensive therapy immediately after surgery, while the other 12 had a significant BP [blood pressure] reduction in the 1st postoperative wk (141 .+-. 3.7 to 110 .+-. 1.6 mm Hg). With longer follow-up, 6 patients remained normotensive (group 1), while the other 6 had residual hypertension (group 2). There was no significant difference between the 2 groups as regards age, preoperative BP level, plasma renin activity, blood volume or response to [Sar1, Thr8]A II. Clinical signs were most helpful in predicting response to surgery. Cured patients had shorter duration of hypertension (less than 1 yr) than patients with residual hypertension, and less impairment of renal excretory function; 3 patients in group 2 but none in group 1 had a history of malignant hypertension. The decision to operate remains a multifactorial evaluation and cannot be based on results of any single test alone.