Recent advances in antihypertensive drug therapy and in intensive risk factor management prompted the undertaking of prospective randomized trials that compared percutaneous renal angioplasty (PTRAS) with medical therapy. Unexpectedly, these trials failed to show compelling benefits of revascularization when added to effective medical therapy. However, they had serious limitations, which raised a number of criticisms, and limited to weight of their conclusions. Hence, clinicians are still left with uncertainties as to whether and in what patients revascularization should be pursued.