Health Encyclopedia

Renovascular hypertension

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.

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

Treatment

Renovascular hypertension is often difficult to treat.

Medications may be used to help control blood pressure. There are a variety of high blood pressure medications available. You and your doctor will decide which type is best for you.

Everyone responds to medicine differently. Your blood pressure should be checked frequently. The amount and type of medicine you take may need to be changed from time to time.

Further treatment depends on what causes the narrowing of the kidney arteries. In some cases, surgery to reconstruct the damaged artery may be done. Persons with renal artery stenosis may have a stent placed in the artery to hold it open.

A surgical bypass of the renal arteries (revascularization) may be done to restore blood flow in patients who have severe high blood pressure, episodes of flash pulmonary edema, or rapid worsening of kidney failure.

Complications

Calling your health care provider

Call for an appointment with your health care provider if you think you have high blood pressure.

Call your health care provider if you have renovascular hypertension and symptoms get worse or do not improve with treatment. Also call if new symptoms develop.

Prevention

Preventing atherosclerosis may prevent the development of renal artery stenosis.

Lifestyle changes may reduce your risk of high blood pressure. Lose weight if you are overweight. Excess weight makes the heart work harder. Check with your doctor before starting a rigorous exercise program.

Changes in your diet may help to control your blood pressure. Reduce the amount of salt (sodium)you use. Salt, MSG, and baking soda all contain sodium.

References

White CJ. Catheter-based therapy for atherosclerotic renal artery stenosis. Circulation. 2006;113:1464-1473.

Balk E, Raman G, Chung M, Ip S, Tatsioni A, Alonso A, et al. Effectiveness of management strategies for renal artery stenosis: a systematic review. Ann Intern Med. 2006;145:901-912.

Textor SC. Renovascular hypertension update. Curr Hypertens Rep. 2006;8:521-527.

Victor RG. Arterial Hypertension. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.

U.S. Preventive Services Task Force. Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2007 Dec 4;147(11):783-6.

Wolff T, Miller T. Evidence for the reaffirmation of the U.S. Preventive Services Task Force recommendation on screening for high blood pressure. Ann Intern Med. 2007 Dec 4;147(11):787-91. Review.

Review Date:4/14/2008
Reviewed By:Parul Patel, MD, Private Practice specializing in Nephrology and Kidney and Pancreas Transplantation, Affiliated with California Pacific Medical Center, Department of Transplantation, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.