Pathophysiology of renovascular hypertension

Hypertension secondary to renovascular disease is the most prevalent form of surgically treatable hypertension. Since the observation by Goldblatt and coworkers in 1934 that placement of an arterial clamp on the renal artery of dogs could lead to an elevated blood pressure, this model has become a standard for experimental studies of hypertension and its complications. Perhaps more than with any other secondary cause of high blood pressure, clinical diagnosis and management of the disorder in man depend upon understanding its pathophysiology. It is in hypertension caused by renal arterial stenosis that the pathogenetic role of the renin-angiotensin system is most firmly established, although it is by no means the only factor. Conversely, a large part of our understanding of the role and regulation of the renin-angiotensin system derives from studies in renal artery clip models. It is the objective of this article to summarize the current-understanding of the pathogenesis and evolution of renovascular hypertension.