
renal factors in the pathogenesis of hypertension
renal arteriography and other modern diagnostic procedures have provided
the means of establishing a close relationship between high blood pressure and
renovascular disease.  many of these cases are amenable to surgical cure.  at
the present time there is no single test for the definitive diagnosis of renal
hypertension.  careful and intensive studies are mandatory in the selection of
cases suitable for surgery, since hypertension has many etiologic factors and
involves many complex and sometimes obscure mechanisms.  aortography,
intravenous urography and split-function tests are among the most important
methods for definitive diagnosis and for the planning of appropriate surgical
procedures.
at operation, the most commonly observed cause of renal arterial con-
striction in the elderly is atherosclerosis, whereas in younger patients it is
hyperplasia of the intimal and muscular coats of the renal artery and its
branches.  renovascular surgery may require a variety of technical procedures.
in the successful cases there is a striking and permanent reduction in blood
pressure.
the accuracy of blood pressure readings is emphasized, since hypertension
is usually discovered for the first time during the course of a routine
physical examination.
