Renovascular hypertension. Clinical and diagnostic clues

Renovascular hypertension (RVH), although relatively rare, is the most frequent among the secondary forms of arterial hypertension; in addition interventional radiology has remarkably increased, because of its relative invasiveness, the possibilities of treating and in many cases curing RVH bypassing the traditional surgical approach. For these reasons in recent years a number of screening tests has been developed and added to renal angiography and to the measurement of plasma renin which, still now, represent the reference methods among the morphological and the functional tests respectively. These new and promising techniques include the magnetic resonance angiography, the spiral computed tomography, the renal scintigraphy and the ultrasound scanning of renal arteries with the associated measurement of velocimetric indices. In selected populations all these methods have been shown to possess an high specificity and sensitivity but if applied to a general population of hypertensive patients their positive predictive values are going to be necessarily low because of the low prevalence of the disease. Accordingly, it is mandatory for the physician, before sending patients to these investigations, to preselect those who, on the basis of a thorough clinical examination are more likely to harbour a renal artery stenosis.