Diagnosis and management of renovascular hypertension

Renovascular hypertension caused by renal artery stenosis accounts for a small portion of overall hypertension but remains important as the most common potentially curable form of high blood pressure. Diagnosis depends on developing an index of suspicion for renovascular hypertension based on the history and physical exam, as well as judicious use of noninvasive and invasive testing. Determining which noninvasive diagnostic test to use remains a persistent dilemma. Treatment options include renal artery angioplasty, arterial stenting, surgery, and medical therapy. The goals of therapy are reduction of blood pressure and protection of renal function. This review discusses the pathophysiology and epidemiology of renovascular hypertension, various noninvasive tests used in diagnosis, and results offered by different treatment modalities. A diagnostic and therapeutic algorithm is offered based on a review of the literature and the experience at our institution.