Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • onset of HTN age <30 years
  • onset of hypertension (HTN) age >55 years
  • history of accelerated, malignant, or resistant HTN
  • history of unexplained kidney dysfunction
  • history of multivessel coronary artery disease
  • history of other peripheral vascular disease
  • abdominal bruit
  • sudden or unexplained recurrent pulmonary edema

Other diagnostic factors

  • absence of family history of HTN
  • other bruits
  • history of acute kidney injury after administration of ACE inhibitor or angiotensin II receptor antagonist
  • history of unexplained congestive heart failure
  • refractory angina
  • history of hypokalemia

Risk factors

  • dyslipidemia
  • smoking
  • diabetes
  • female sex

Diagnostic investigations

1st investigations to order

  • serum creatinine
  • serum potassium
  • urinalysis and sediment evaluation
  • aldosterone-to-renin ratio
Full details

Investigations to consider

  • duplex ultrasound
  • gadolinium-enhanced MR angiography (MRA)
  • CT angiography
  • conventional angiography
  • carbon dioxide (CO2) angiography
  • noncontrast magnetic resonance angiography
  • captopril radionuclide renal scan
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

University of Massachusetts Medical School

UMass Memorial Medical Center

Worcester

MA

Disclosures

RM declares that he has no competing interests.

Assistant Professor of Medicine

University of Massachusetts Medical School

UMass Memorial Medical Center

Worcester

MA

Disclosures

AA declares that he has no competing interests.

RM and AA would like to gratefully acknowledge Dr Manmeet Singh and Dr Scott J. Gilbert, previous contributors to this monograph. MS and SJG declare that they have no competing interests.

Peer reviewers VIEW ALL

Associate Professor

Department of Family Medicine

University of Texas Health Science Center

Tyler

TX

Disclosures

RT declares that he has no competing interests.

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Disclosures

IM declares that he has no competing interests.

Professor

Aberdeen Royal Infirmary

Foresterhill

Scotland

Disclosures

JW declares that he has no competing interests.

Grover E. Murray Professor

University Distinguished Professor

Texas Tech University Medical Center

Lubbock

TX

Disclosures

NAK declares that he has no competing interests.

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