DISEASES OF THE AORTA, PULMONARY AND PERIPHERAL VESSELS: Edited by Alan BravermanManagement of renovascular hypertensionTextor, Stephen C.Author Information Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA Correspondence to Stephen C. Textor, MD, Professor of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA. Tel: +1 507 284 4083; e-mail: [email protected] Current Opinion in Cardiology: November 2020 - Volume 35 - Issue 6 - p 627-635 doi: 10.1097/HCO.0000000000000790 Buy Metrics Abstract Purpose of review Renovascular occlusive disease remains a common cause of resistant and rapidly progressive hypertension. The present review summarizes current practice regarding management of renovascular hypertension (RVH). Recent findings Current data using blood oxygen level dependent MR emphasize the tolerance of the kidney to moderate reductions in blood flow and the efficacy of antihypertensive drug therapy for many individuals. Prospective trials have failed to identify benefits of revascularization for moderate disease, either regarding blood pressure or renal function. Antihypertensive drug therapy including renin-angiotensin system blockade is central to management of RVH. Recent and ongoing observational studies report important improvements after revascularization regarding blood pressure, management of refractory or ‘flash’ pulmonary edema, and survival in specific ‘high risk’ clinical populations not included in randomized trials. Research directions underscore the role of adjunctive measures, including mitochondrial protection, therapeutic angiogenesis, and cell-based regenerative repair to protect kidney function in RVH. Summary Clinicians should recognize the potential for disease progression to threaten renal function with severe and prolonged renal ischemia. Improved patient selection for true resistant hypertension with RVH and ‘high-risk’ clinical manifestations is critical to identify those likely to benefit from renal revascularization. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.