Advances in noninvasive screening for renovascular disease

Abstract

Nearly 50 million Americans have hypertension, and renovascular hypertension accounts for perhaps 1% of them. To review the current recommendations and the available screening tests for renovascular hypertension. The presence of clinical clues increases the predictive value of screening tests for renovascular hypertension; these include abrupt onset of hypertension before age 30 or after age 55, severe hypertension, accelerated or malignant hypertension, hypertension refractory to a triple-drug regimen, moderate hypertension with diffuse vascular disease, an epigastric bruit, moderate hypertension with unexplained azotemia, and azotemia induced by an angiotensin-converting enzyme inhibitor. Captopril renography and duplex ultrasonography are clinically useful screening tools, but wide variation in accuracy exists among institutions. Magnetic resonance angiography may emerge as an effective clinical test. A thorough history and physical examination, coupled with judicious use of available screening technology, can help determine if a patient has renovascular hypertension and may benefit from intervention.