Renovascular hypertension Health Article

Definition

Renovascular hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys. It is a form of secondary hypertension.

See also:

• Drug-induced hypertension
• Essential hypertension
• Malignant hypertension
• Renal artery stenosis

Alternative Names

Renal hypertension; Hypertension - renovascular

Causes, incidence, and risk factors

When the kidney arteries become narrow, less blood flows to the kidneys. The kidneys mistakenly respond as if your blood pressure is low and give off hormones that tell the body to retain salt and water. This causes your blood pressure to rise.

Many different diseases can cause narrowing of the renal arteries. Hardening of the arteries from high cholesterol is one of the most common. Most patients have the typical risk factors for atherosclerosis, including high blood pressure, high cholesterol, and diabetes.

Fibromuscular dysplasia is another cause, particularly in women under age 50.

Symptoms

Usually, high blood pressure causes no symptoms. Occasionally you may have a mild headache. If your headache is severe, or if you have any of the symptoms below, see a doctor right away. These may be a sign of malignant hypertension.

• Blood in urine
• Confusion
• Crushing, angina-like chest pain
• Ear noise or buzzing
• Irregular heartbeat
• Nosebleed
• Tiredness
• Vision changes

Signs and tests

Persons with renovascular hypertension usually have severe, difficult-to-control high blood pressure. Elevated blood pressure measurements, repeated over time, confirm hypertension.

Your doctor may hear a "whooshing" noise, or bruit, when placing a stethoscope over your belly area.

Other signs of this disease include:

• Episodes of heart failure (flash pulmonary edema)
• Rapid progression of kidney failure
• Acute kidney failure occurs when starting blood pressure medicines called ACE-I or ARBs
• Hypertension in an elderly patient whose blood pressure was previously well controlled

There may be signs of complications, such as:

• Left ventricular hypertrophy (swelling of the heart)
• Hypertensive retinopathy

Your doctor may order blood tests to check your renin and aldosterone levels. Imaging tests may be done see if the kidney arteries have narrowed. They include:

• Renal arteriography
• Doppler ultrasound of the renal arteries
• Magnetic resonance angiography (MRA)
• Angiotensin converting enzyme (ACE) inhibition renography