[Renovascular hypertension: comparison between transluminal dilatation and surgical procedures].

Percutaneous transluminal dilatation (PTD; n = 45) was compared with surgical procedures (n = 51) in 96 patients with renovascular hypertension. Since cases with atherosclerotic stenosis (ASS) are known to show a different response to surgery than those with fibromuscular dysplasia (FMD), group-specific analysis was performed. In their two subgroups (ASS and FMD) both surgical and dilated patients showed comparable mean age and sex distribution and serum creatinine. However, differences were observed in mean duration of hypertension and in pretreatment blood pressure values: surgical patients with ASS and FMD showed a lower mean duration of hypertension (operation: ASS 3.2, FMD 1.9 years; PTD: ASS 5.1, FMD 3.4 years) and higher mean blood pressure values (surgery: ASS 207/121, FMD 209/126 mm Hg; PTD: ASS 199/115, FMD 175/108 mm Hg). After a mean observation period of 2.6 years mean blood pressure fell in the surgery group to 147/90 mm Hg in the 26 cases with ASS, and to 139/87 mm Hg in the 25 patients with FMD. In dilated cases respective blood pressure values were 145/90 mm Hg (ASS, n = 17) and 132/84 mm Hg (FMD, n = 11). These results show a comparable blood pressure lowering effect for surgery and dilatation in renovascular hypertension. In cases with lengthy stenosis or involvement of primary branches of the renal artery and in those with aortic or poststenotic renal aneurysm a surgical technique should be performed, whereas in the remaining cases PTD represents a favourable procedure.