Detection and treatment of renovascular disease: 40 years on

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This year marks the 60th anniversary of the publication of Goldblatt's original demonstration that constricting the renal arteries of the dog was capable of causing sustained elevation of arterial pressure [1]. The success of those experiments depended not only on the ingenious design of the adjustable silver clamps which narrowed the arteries, but also on the ability to make accurate recordings of systolic blood pressure from day to day via external carotid loops. Translation from the laboratory to clinical practice was slow, and 20 years elapsed before Howard et al. [2] were able to show amelioration of hypertension after nephrectomy in a series of six patients in whom renovascular disease was suspected. That early series did not use angiography, which only later became established as the main technique for diagnosis.

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