New insights on renovascular hypertension

Although activation of the endocrine renin-angiotensin system with consequent vasoconstriction and salt retention have long been known as the hallmarks of the early phase of renovascular hypertension, the recent recognition of a local vascular angiotensin system and the understanding of the process of vascular remodeling provide new insights into the pathophysiology of this form of hypertension. New pathophysiologic insights as well as technological advances are beginning to alter longstanding clinical approaches to this disease. For example, the captopril renogram has emerged as the screening test of choice in diagnostic evaluation. In addition, new imaging modalities such as magnetic resonance angiography and spiral computed tomography show promise for providing noninvasive anatomical characterization of renovascular disease. Moreover, therapeutic strategies have advanced as a result of better understanding of the natural history of the disease, more effective pharmacologic therapy, and advances in revascularization techniques, such as intravascular stents. This review focuses on these intriguing new developments.