Renovascular hypertension: clinical concepts

Systemic hypertension is a common disorder in clinical practice and causes significant morbidity and premature death. A small percentage (< 5%) of patients with hypertension may have renovascular hypertension. Strictly speaking, the term renovascular hypertension should be applied only when the blood pressure rises as a consequence of renal ischemia. Thus, the mere presence of renal artery stenosis is not synonymous with renovascular hypertension. Treatment strategies should be directed at ''renovascular hypertension'' rather than an anatomic renal artery stenosis (which may be discovered accidentally). Management of renal artery stenosis/renovascular hypertension is imprecise at best. This article discusses the patho-physiology of renovascular hypertension and how to approach a patient with renal artery stenosis.