Summary
Definition
History and exam
Key diagnostic factors
- onset of hypertension age >55 years
- history of accelerated, malignant, or resistant hypertension
- 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
- onset of hypertension age <30 years
Other diagnostic factors
- absence of family history of hypertension
- 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 tests
1st tests to order
- serum creatinine
- serum potassium
- urinalysis and sediment evaluation
- aldosterone-to-renin ratio
Tests 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
Treatment algorithm
atherosclerotic RAS
fibromuscular dysplasia
Contributors
Authors
Mauricio Leitao, MD, MBA
Clinical Research Coordinator
University of Massachusetts Chan Medical School
UMass Memorial Medical Center
Worcester
MA
Disclosures
ML declares that he has no competing interests.
Alvaro Alonso, MD, MSCR, FSVM
Associate Professor of Medicine
University of Massachusetts Chan Medical School
UMass Memorial Medical Center
Worcester
MA
Disclosures
AA declares that he has no competing interests.
Acknowledgements
Dr Alvaro Alonso and Dr Mauricio Leitao would like to gratefully acknowledge Dr Rohit Malhotra, Dr Manmeet Singh and Dr Scott J. Gilbert, previous contributors to this topic. RM, MS and SJG declare that they have no competing interests.
Peer reviewers
Robert Tompkins, MD
Associate Professor
Department of Family Medicine
University of Texas Health Science Center
Tyler
TX
Disclosures
RT declares that he has no competing interests.
Irfan Moinuddin, MD
Assistant Professor
Chicago Medical School
Rosalind Franklin University
Lombard
IL
Disclosures
IM declares that he has no competing interests.
John Webster, MD
Professor
Aberdeen Royal Infirmary
Foresterhill
Scotland
Disclosures
JW declares that he has no competing interests.
Neil A. Kurtzman, MD
Grover E. Murray Professor
University Distinguished Professor
Texas Tech University Medical Center
Lubbock
TX
Disclosures
NAK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Parikh SA, Shishehbor MH, Gray BH, et al. SCAI expert consensus statement for renal artery stenting appropriate use. Catheter Cardiovasc Interv. 2014 Dec 1;84(7):1163-71.Full text Abstract
Gornik HL, Persu A, Adlam D, et al. First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med. 2019 Jan 16;24(2):164-89.Full text Abstract
Anderson JL, Halperin JL, Albert NM, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Apr 2;127(13):1425-43.Full text Abstract
Aboyans V, Ricco JB, Bartelink ME, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018 Mar 1;39(9):763-816.Full text Abstract
American College of Radiology. ACR appropriateness criteria: renovascular hypertension. 2017 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Essential hypertension
- Acute kidney injury
- Renal artery dissection
More DifferentialsGuidelines
- 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS)
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
More GuidelinesPatient information
High blood pressure
High cholesterol
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer