Hipertensión renovascular: actualización

Renovascular hypertension (RVHT) is a frequent and potentially correctable cause of secondary arterial hypertension (HT). Its incidence varies depending on the clinical setting. Renal artery stenosis (RAS) is found in 1% of patients with mild HT and in up to 10-45% in patients with severe HT or with accelerated evolution. The most frequent causes of RAS are atherosclerotic vascular disease and fibromuscular dysplasia (FMD), which are found in a ratio 9:1 in favor of the atherosclerotic disease. RVHT usually occurs in a context of high cardiovascular comorbidity, coexisting with coronary heart disease (10-14%), peripheral arterial disease (15-25%), cerebrovascular (10%), aortic (25-35%) and advanced chronic kidney disease (CKD) (35%), among others. Diagnostic and therapeutic difficulties arise in different clinical scenarios. Some of the questions un-derlying the approach of these patients are: should I look for RAS in a specific patient? What is the most appropriate form of study? Should I carry out medical and / or interventional treatment in a specific patient? We review these questions from a clinical approach and based on the “state of the art”. Given the preponderant role of atherosclerotic disease due to its frequency, the emphasis will be placed on it. Much more than other pathologies, the RVHT approach must be in a team, integrating the different disciplines in decision-making.