XVI. Assessment for renovascular hypertension

Diagnosis and Assessment

Recommendations

  1. Patients who present with 2 or more of the following clinical clues, which suggest renovascular hypertension, should be investigated (Grade D):
    1. Sudden onset or worsening of hypertension and age older than 55 or younger than 30 years;
    2. Presence of an abdominal bruit;
    3. Hypertension resistant to 3 drugs;
    4. Increase in serum creatinine level 30% associated with use of an ACE inhibitor or ARB;
    5. Other atherosclerotic vascular disease, particularly in patients who smoke or have dyslipidemia;
    6. Recurrent pulmonary edema associated with hyper-tensive surges.
  2. The following tests are recommended for screening for atherosclerotic renal vascular disease: captopril-enhanced radioisotope renal scan (for patients with eGFR > 60 mL/min/1.73 m2), Doppler sonography, computed to-mography angiography, and magnetic resonance angiog-raphy (for patients with eGFR > 30 mL/min/1.73 m2; Grade D; revised recommendation).
  3. Patients with hypertension who present with at least 1 of the following clinical clues should be investigated for fibromus-cular dysplasia (FMD)-related renal artery stenosis (Grade D):

    1. Significant (> 1.5 cm), unexplained asymmetry in kidney sizes;
    2. Abdominal bruit without apparent atherosclerosis;
    3. FMD in another vascular territory;
    4. Family history of FMD.
  4. In patients with confirmed renal FMD (Grade D):
    1. Screening for cervicocephalic lesions and intracranial aneurysm is recommended;
    2. Screening for FMD in other vascular beds in the pres-ence of suggestive symptoms is recommended.
  5. The following tests are recommended to screen for renal FMD (both with similar sensitivity and specificity; Grade D): magnetic resonance angiography and computed to-mography angiography.