cardiovascular disorders
Renovascular Hypertension
Key Points
Stenosis (> 70%) or occlusion of a renal artery can cause hypertension by stimulating release of renin from juxtaglomerular cells of the affected kidney. About 80% of cases are caused by atherosclerosis, and 20% by fibromuscular dysplasia. Suspect a renovascular cause if diastolic hypertension develops abruptly in a patient<30 years or>50 years; if new or previously stable hypertension rapidly worsens within 6 months; or if hypertension is initially severe (systolic > 180 mm Hg), associated with worsening renal function, or highly refractory to treatment with medication. Do ultrasonography, magnetic resonance angiography, or CT angiography to identify patients who should have renal angiography, the definitive test. Give aggressive medical treatment of hypertension, atherosclerosis, and related disorders. For patients with fibromuscular dysplasia, consider percutaneous transluminal angioplasty and/or stent placement or rarely a vascular bypass graft. 