Balloon angioplasty versus medical therapy for patients with renal artery obstruction and high blood pressure

Atherosclerosis can cause narrowing and hardening of the main blood vessel supplying the kidneys (renal artery stenosis) and resulting high blood pressure. Even using drugs that lower blood pressure (antihypertensives), atherosclerotic renal artery narrowing tends to progress. Poor blood flow results in a lack of oxygen (renal ischaemia) and loss of kidney function, causing kidney failure and death. Currently, possible treatments are medical treatment with blood pressure lowering drugs, insertion of a balloon-like tube which is inflated to open up the renal artery (balloon angioplasty, with and without stents), insertion of a tube to open up the artery with stents, and surgery to reconstruct the artery. The review authors identified three controlled trials in which a total of 210 adults were randomized to have balloon angioplasty or drug treatment only. Those treated with balloon angioplasty required less antihypertensive drugs in two trials and were more likely to have open renal arteries after 12 months. The data were insufficient to show that one treatment was better than the other in lowering blood pressure. Renal function was similar with balloon angioplasty and drug treatment. Balloon angioplasty appears to be safe and there were fewer cardiovascular and renovascular complications in participants treated with angioplasty. Where high blood pressure is not reduced sufficiently with drugs, balloon angioplasty may help.