Management of hypertension of renal origin

Studies as clinically warranted were accomplished in more than 2,000 patients seen from January 1964 through December 1968 because of hypertension and suspected or proved renal disease. Data from the clinical history, physical examination, laboratory investigation and results of surgical or medical treatment are reported for 100 cases each of 5 entities—glomerulonephritis, pyelonephritis, renal cyst, renal tumor and apparent primary hypertension with renal disease. Comparison is made with data included from 100 cases of renal artery stenosis and hypertension. Female patients numbered 286, and predominated in the groups with renal artery stenosis and with pyelonephritis. Ages ranged from 6 to 81 years. Hypertension was less severe in the groups with renal tumor or cyst. Hypertensive changes of the retinal arterioles were more severe in the group with renal artery stenosis and in the group with primary hypertension, and renal function was more severely impaired with glomerulonephritis and primary hypertension. Surgical treatment was given 234 patients, 71 of whom later had normal blood pressures without medical treatment. For 366 patients medical treatment was primary; 125 of these usually maintained diastolic blood pressure of less than 90 mm Hg. Sodium restriction proved a valuable part of conservative management in most cases. Dialysis or transplantation, or both, were required for 49 patients. In the 600 cases, 507 patients are alive 2 to 13 years after initial examination, and 93 have died.