Long-term prognosis of surgical treatment of renovascular hypertension.

During the period 1974-1986, 71 patients were operated on for renovascular hypertension. Forty-eight patients had atherosclerotic disease and 23 patients had fibromuscular dysplasia. There was no operative mortality. Fourteen patients died during the follow-up, 12 of them from cardiovascular causes. The 57 surviving patients were reexamined with a mean follow-up of 7 years. The relative cumulative 5- and 10-year survival rates in all patients were 79% and 55%, respectively. At follow-up, seven (19%) of the atherosclerotic patients were classified as cured, 22 (59%) as improved and eight (22%) as failures. In the patients with fibromuscular dysplasia, 12 (60%) were normotensive without medication, and six (30%) were improved. The relative 5-year survival rates in these aetiological groups were 73% and 90%, respectively. Only complete cure of hypertension by surgery predicted a good outcome, whereas very similar survival curves were found in the improved and failed groups. This could be due to a higher incidence of target organ changes before surgery in the latter groups. A positive blood pressure response to long-term converting-enzyme inhibition correlated well with the response to surgery. Renal venous renin studies correctly predicted long-term outcome of surgery in 78% of the patients studied, but require careful preparation of the patients and interpretation of results.