Renovascular hypertension

Alternative Names

Symptoms

Usually, high blood pressure causes no symptoms. Occasionally you may have a mild headache. If your headache is severe, or if you have any of the symptoms below, see a doctor right away. These may be a sign of malignant hypertension.

• Blood in urine
• Confusion
• Crushing, angina-like chest pain
• Ear noise or buzzing
• Irregular heartbeat
• Nosebleed
• Tiredness
• Vision changes

Exams and Tests

Persons with renovascular hypertension usually have severe, difficult-to-control high blood pressure. Elevated blood pressure measurements, repeated over time, confirm hypertension.

Your doctor may hear a "whooshing" noise, or bruit, when placing a stethoscope over your belly area.

Other signs of this disease include:

• Episodes of heart failure (flash pulmonary edema)
• Rapid progression of kidney failure
• Acute kidney failure occurs when starting blood pressure medicines called ACE-I or ARBs
• Hypertension in an elderly patient whose blood pressure was previously well controlled

There may be signs of complications, such as:

• Left ventricular hypertrophy (swelling of the heart)
• Hypertensive retinopathy

Your doctor may order blood tests to check your renin and aldosterone levels. Imaging tests may be done see if the kidney arteries have narrowed. They include:

• Renal arteriography
• Doppler ultrasound of the renal arteries
• Magnetic resonance angiography (MRA)
• Angiotensin converting enzyme (ACE) inhibition renography

References

White CJ. Catheter-based therapy for atherosclerotic renal artery stenosis. Circulation. 2006;113:1464-1473.

Balk E, Raman G, Chung M, Ip S, Tatsioni A, Alonso A, et al. Effectiveness of management strategies for renal artery stenosis: a systematic review. Ann Intern Med. 2006;145:901-912.

Textor SC. Renovascular hypertension update. Curr Hypertens Rep. 2006;8:521-527.

Victor RG. Arterial Hypertension. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

U.S. Preventive Services Task Force. Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2007 Dec 4;147(11):783-6.

Wolff T, Miller T. Evidence for the reaffirmation of the U.S. Preventive Services Task Force recommendation on screening for high blood pressure. Ann Intern Med. 2007 Dec 4;147(11):787-91. Review.