Renovascular hypertension: Predicting surgical cure with exercise renography

• Published in: Journal of vascular surgery Vol. 14; no. 2; pp. 200 - 207
• Main Authors: Hupp, Thomas, Clorius, John H., Allenberg, Jens R.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.1991; Elsevier
• Subjects: Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Cardiology. Vascular system; Exercise Test - methods; Humans; Hypertension, Renovascular - diagnostic imaging; Hypertension, Renovascular - physiopathology; Hypertension, Renovascular - surgery; Iodohippuric Acid; Medical sciences; Postoperative Period; Posture; Prognosis; Prospective Studies; Radioisotope Renography - methods; Remission Induction; Single-Blind Method; Radionuclide study; Human; Hypertension; Prognosis; Renal artery; Stenosis; Cardiovascular disease; Exercise tolerance test
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.1991.29810

Renal artery stenosis with resultant renovascular hypertension has attracted clinical attention because the disease is potentially curable and because numerous diagnostic and therapeutic modalities compete for clinical acceptance. An exercise-mediated disturbance of renal hippurate transport was recently described, and has been implicated as having a role in nephrogenic fixed hypertension. To predict the final course of renovascular hypertension before operation we carried out a prospective study with the goal of verifying the predictive value of exercise hippurate scintigraphy. The study was to test the hypothesis that patients with disturbance of renal hippurate transport (pathologic renogram) induced by exercise would have stabilized hypertension and would continue to be hypertensive after operation. Thirty-one patients with hypertension who had unilateral or bilateral renovascular stenosis documented on angiography were referred to rest and exercise hippurate scintigrams before operation. The results of the examinations at rest served as standard and were compared with the exercise scintigrams. In 19 of the 31 (61%) patients a disturbance of transrenal hippurate transport evolved during exercise, whereas 12 (39%) patients failed to respond to exercise with altered hippurate kinetics. Twenty-six patients went on to renovascular operations; five had percutaneous transluminal angioplasty. Revascularization results differed markedly when the blood pressure response of patients with positive results on exercise (abnormal) and patients with negative results on exercise (normal) were compared. Ten of 12 patients with hypertension who had normal exercise renograms were cured. In comparison, blood pressure values were little influenced by therapy in patients with an abnormal response, where 17 of 19 patients continued to have hypertensive disease after therapy. It is most important to note that the transitory tracer transport abnormality is easily recognized on scintigraphy. The study shows that exercise scintigraphy helps identify patients with curable renovascular hypertension and thus predicts which patients will benefit most from operation. (J V ASC S URG 1991;14:200-7.)