The goals of therapy for renovascular hypertension (RVH) are effective control of hypertension and preservation of renal function. The three therapeutic options include medical therapy, angioplasty and surgical revascularization, and the clinician must individualize the therapeutic options. Results of angioplasty for fibromuscular dysplasia have been excellent and quite comparable to surgical revascularization, and so is the initial choice in younger patients with fibrodysplasia. However, in patients with atherosclerosis, earlier reports suggested the superiority of surgical intervention over medical therapy, but recently randomized trials comparing clinical treatment and angioplasty have shown similar results in relation to blood pressure control and renal function. Renal artery stent has become an important adjunct to angioplasty, specially in patients with atherosclerotic renal ostial lesions, and it has been associated with an improvement of blood pressure control and stabilization of renal function.