Diagnostic criteria for renovascular hypertension

Renovascular hypertension is a clinical situation characterized by high blood pressure in the presence of renal ischemia mainly related to atherosclerotic or fibromuscular dysplasic narrowing of the renal artery (ies). This diagnosis is often "a posteriori" validated, because the discovery of a significant renal artery stenosis is not obligatory responsible of the blood pressure elevation. This article proposes a diagnostic strategy for exploring patient with this suspected secondary cause of hypertension before proposing an invasive approach (intra-arterial angiography) possibly followed by a revascularization. However, the methods for exploring such population are mainly based on patient characteristics and local expertise and habits. These must thus be individualized. First, clinical symptoms or signs frequently associated with hypertension and renal artery stenosis must be searched. If present, a non invasive and functional exploration of the renal arteries is to be proposed (Captopril radioisotope renography, colour duplex sonography) followed by magnetic resonance angiography or spiral computer tomography angiography if the clinical suspicion index is moderate or high. If this is very high, an intra-arterial arteriography could immediately be performed if not too dangerous. On the opposite site, if the clinical index is low, it is recommended to follow clinically and to treat risk factors.