Renovascular hypertension

Alternative names:

hypertension - renovascular; renal hypertension

Symptoms:

• blood pressure, high
• headache (occasionally)

If hypertension is severe, symptoms include:

• tiredness
• confusion
• vision changes
• nausea, vomiting
• anxiety
• excessive perspiration
• pale skin, or redness
• angina-like chest pain (crushing substernal chest pain)

Note: Most often, no symptoms are present.

Signs and tests:

Elevated blood pressure measurements, repeated over time, confirm hypertension. Renovascular hypertension is often severely high and refractory (difficult to treat). Diastolic blood pressure (the "bottom" number, a reflection of the pressure in blood vessels when the heart is at rest) is often higher than 104 (normal is less than 90). Renovascular hypertension is suspected when the onset of hypertension occurs at an advanced age; stable, controlled hypertension becomes more difficult to treat; or when new-onset hypertension requires multiple medications for its satisfactory control. There may be signs of complications. Bruits ("whooshing" noises over an artery) may be heard with a stethoscope over the abdomen or flank areas.

Atherosclerosis or renal stenosis may show on:

• renal scan testing that includes administration of an angiotensin-converting enzyme (ACE) inhibitor such as captopril
• renal angiography (injection of dye into the renal artery so that a narrowing of the artery can be seen on an X-ray)
• intravenous pyelogram that shows slow uptake in one or both kidneys

This disease may also alter the level of renin if that is tested.