CLINICAL COURSE OF ATHEROSCLEROTIC RENOVASCULAR DISEASE

The clinical course of atherosclerotic renovascular hypertension was evaluated in 109 patients, and the changes in the renal artery disease were observed by serial renal arteriography in 30 patients. The estimated five year survivorship was 66.7 ± 6.4 per cent, compared to 91.7 per cent in the normal population. Associated symptomatic cardiovascular disease (angina, myocardial infarction, transient or completed stroke, intermittent claudication) was noted in 41 per cent at the initial examination, and 39 per cent of those initially free developed this during the period of observation. These episodes frequently were multiple and were not related to continued hypertension. The five year survivorship free of symptomatic cardiovascular disease was estimated to be 53.2 ± 8.0 per cent. Renovascular surgery in 46 patients did not affect survivorship. The incidence of new symptomatic cardiovascular disease was higher in the surgical group. Blood pressures were 100 mm. Hg or less at follow-up in 86 per cent of the surgically treated group and in 65 per cent in the medically treated group. Good blood pressure control appeared to improve the prognosis for life but not for symptomatic cardiovascular episodes. The serial studies of the renal vasculature in 30 patients demonstrated progression of the disease in half of the involved arteries. Three previously normal arteries became diseased. Changes for the worse were noted in the artery to one kidney in 13 patients (including 2 with prior nephrectomy) and in the arteries to both kidneys in 6. The progressive nature of renal artery atherosclerosis was reflected by impairment of function and loss of mass (clearance studies and isotopic and excretory urography); the converse was often true after successful revascularization of affected kidneys. In the presence of hypertension, atherosclerotic disease in other parts of the body should suggest the possibility of renal artery involvement. In view of the progressive nature of atherosclerosis in general, the status of the heart, brain and peripheral arteries also should be assessed initially and periodically regardless of the degree of blood pressure control. © 1968.