ACR Appropriateness Criteria® Renovascular Hypertension: Update 2026

Area of Science:

• Nephrology
• Cardiology
• Radiology

Background:

• Renovascular hypertension is the most frequent cause of secondary hypertension.
• It affects 0.5% to 5% of hypertensive individuals, particularly those with resistant hypertension or end-stage kidney disease.
• Clinical suspicion warrants evaluation for renovascular hypertension.

Purpose of the Study:

• To outline the diagnostic approach for renovascular hypertension.
• To discuss the primary imaging modalities used for assessment.
• To highlight the role of evidence-based guidelines in clinical decision-making.

Main Methods:

• Review of primary imaging modalities: ultrasound, CT with contrast, and MRI.
• Consideration of patient's renal status in modality selection.
• Application of American College of Radiology Appropriateness Criteria and RAND/UCLA methodology.

Main Results:

• Ultrasound offers nonionizing radiation benefits.
• CT with contrast provides superior spatial resolution.
• MRI is a reliable option for patients with compromised renal function.

Conclusions:

• Imaging modality selection for renovascular hypertension is patient-specific, considering renal function.
• Evidence-based guidelines and expert consensus inform diagnostic recommendations.
• Systematic analysis of medical literature and established methodologies support guideline development.