Non-Stent, Non-Medication Options for Cardiovascular Disease Management
For renovascular hypertension caused by fibromuscular dysplasia, angioplasty without stenting is the primary non-medication intervention that doesn't require long-term pharmacological therapy and rarely recurs. 1
Angioplasty Without Stenting for Renovascular Disease
Angioplasty without stenting is specifically recommended for fibromuscular dysplasia as a definitive treatment option that eliminates the need for ongoing medication. 1 This intervention is particularly effective in:
- Female patients in their 30s-50s with fibromuscular dysplasia, where angioplasty alone (without stent placement) provides durable results with rare recurrence 1
- Patients who want to avoid lifelong renin-angiotensin blockade medications that would otherwise be required with medical management 1
Key Clinical Distinction
The evidence clearly differentiates fibromuscular dysplasia from atherosclerotic renovascular disease:
- Fibromuscular dysplasia: Angioplasty without stenting is the preferred intervention 1
- Atherosclerotic disease: Requires either medical therapy with renin-angiotensin blockade OR angioplasty with stenting (not without stenting) 1
Surgical Revascularization (CABG)
For coronary artery disease requiring revascularization, coronary artery bypass grafting (CABG) provides complete revascularization without requiring the dual antiplatelet therapy that stents mandate. 2
- CABG offers superior freedom from repeat revascularization compared to percutaneous interventions 2
- Left internal mammary artery grafts demonstrate excellent 10- and 20-year patency rates, eliminating the need for prolonged antiplatelet medications required after stent placement 2
- CABG remains the treatment of choice for certain types of coronary artery disease, particularly complex multivessel disease 2
Important Caveat
While CABG avoids the need for prolonged dual antiplatelet therapy required after stenting, patients typically still require aspirin and management of cardiovascular risk factors post-operatively. 2 However, this represents a significantly reduced medication burden compared to the dual antiplatelet therapy (aspirin plus P2Y12 inhibitor) required for 6-12 months after drug-eluting stents.
Lifestyle Interventions (Non-Pharmacological Management)
For hypertension and cardiovascular disease prevention, six evidence-based lifestyle interventions can lower blood pressure by 4-11 mm Hg without medications: 1, 3
Primary Interventions with Strongest Evidence
- DASH diet: Reduces systolic BP by 11 mm Hg in hypertensives and 3 mm Hg in normotensives 3
- Weight loss: Approximately 1 mm Hg reduction per kilogram lost, with total reductions of ~5 mm Hg 3
- Sodium reduction: Goal <1,500 mg/day produces 5-6 mm Hg systolic reduction 3
- Potassium supplementation: Goal 3,500-5,000 mg/day produces 4-5 mm Hg reduction (contraindicated in chronic kidney disease) 3
- Structured physical activity: Aerobic exercise 5-7 times/week produces 5-8 mm Hg reduction 3
- Alcohol moderation: ≤2 drinks/day for men, ≤1 for women produces 4 mm Hg reduction 3
Clinical Application Algorithm
For stage 1 hypertension (SBP 130-139 or DBP 80-89 mm Hg), lifestyle interventions alone may be sufficient without medications, particularly when allowed 6-12 months for implementation in the absence of target organ damage. 1, 3
For stage 2 hypertension (≥140/90 mm Hg), lifestyle interventions are essential adjuncts but generally require pharmacological therapy. 1, 3 However, combined lifestyle modifications can facilitate medication dose reduction or step-down in controlled patients. 3
Important Warnings
- Patients with target organ damage (left ventricular impairment, diabetes) require drug treatment regardless of lifestyle modifications 3
- The combination of two or more lifestyle interventions produces substantially greater effects than single interventions 3
- Certain supplements marketed for athletic performance or sexual enhancement may increase blood pressure and should be avoided 3