Clinical analysis was done on the surgical results and prognosis of 24 operated cases with reno-vascular hypertension experienced at the Yokohama City University Hospital and of 202 operated renovascular hypertensives from the collective review of the past Japanese medical literatures.
Following-up on the operated cases revealed that a maximal blood pressure reduction was achieved at the 6th post-operative/month, followed by a gradual but slow elevation of blood pressre 2, 5, and 10 years after the operation.
Analysis on the factors which might influence prognosis of reno-vascular hypertension after surgery revealed the following findings:
1) Age and duration of hypertension had little influence on prognosis of reno-vascular hypertension after surgery.
2) Prognosis of reno-vascular hypertension after surgery was deeply affected by the etiology of renal artery stenosis. The aortitis syndrome which was peculiar in Japan and in the other Asian countries had most poor prognosis in blood pressure reduction associated with a high mortality rate. Fibromuscular hyperplasia showed more favourable prognosis than atherosclerosis.
3) Slightly better blood pressure response was attained by nephrectomy than by angioplastic operation in the collective cases whereas a reverse result was obtained in the author's cases. In the angioplastic group, poor prognosis was indicated when the artificial graft was applied.
4) Favourable blood pressure reduction coluld not be expected if total renal function was lowered or if nephrosclerotic change was present in the stenotic and non-stenotic kidney.
5) Cardiovascular damage was closely correlated to poor prognosis whereas optic fundi change was not.
6) Poor prognosis after surgery could be expected when peripheral plasma renin activity was not elevated significantly, or when renal vein renin ratio between the affected and the unaffected kidney was below 1.5.
