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Renovascular hypertension in blacks

O E Emovon1, P E Klotman, N R Dunnick

  • 1Department of Medicine and Radiology, Duke University Medical Center, Durham, North Carolina, USA.

American Journal of Hypertension
|January 1, 1996
PubMed
Summary

In hypertensive Black patients, captopril stimulated renin and postcaptopril renography are not effective screening tools for renovascular hypertension (RVH). Angiography is recommended for high-risk individuals.

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Area of Science:

  • Nephrology
  • Hypertension
  • Diagnostic Imaging

Background:

  • Renovascular hypertension (RVH) affects a significant portion of hypertensive patients.
  • Early diagnosis and treatment of RVH are crucial for preventing kidney damage.
  • The prevalence and diagnostic utility of RVH screening tests in Black populations require further investigation.

Purpose of the Study:

  • To define the clinical characteristics of renovascular hypertension (RVH) in Black patients.
  • To determine the clinical usefulness of captopril-stimulated peripheral renin (S-PRA) and postcaptopril renography (PC-RENO) in identifying RVH in at-risk Black individuals.

Main Methods:

  • Seventy-nine clinically selected hypertensive Black patients were evaluated.
  • Measurements included unstimulated peripheral renin activity (U-PRA), S-PRA, and PC-RENO.

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  • Conventional renal arteriography was performed on all subjects to confirm diagnoses.

    • Main Results:

    • Renal artery stenosis (RAS) was identified in 18% of patients, and RVH was diagnosed in 9%.
    • S-PRA demonstrated low sensitivity (38%) for RAS and even lower (17%) for RVH.
    • PC-RENO showed moderate sensitivity (64% for RAS, 67% for RVH) but poor specificity (58% for both).

    Conclusions:

    • Captopril-stimulated peripheral renin and postcaptopril renography are not effective screening tools for diagnosing renovascular disease in Black patients.
    • Angiography remains the gold standard for evaluating Black patients at high risk for RVH.
    • Further research may explore alternative diagnostic strategies for this demographic.