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Renovascular hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys. This condition is also called renal artery stenosis.
See: High blood pressure
Renal hypertension; Hypertension - renovascular; Renal artery occlusion; Stenosis - renal artery; Renal artery stenosis
Causes, incidence, and risk factors
When the arteries that carry blood to your kidneys become narrow, less blood flows to the kidneys. The kidneys mistakenly respond as if your blood pressure is low and make hormones that tell the body to hold on to more salt and water. This causes your blood pressure to rise.
Renal artery stenosis is a narrowing or blockage of the artery that supplies blood to the kidneys.
The most common cause of renal artery stenosis is a blockage in the the arteries due to high cholesterol. This problem occurs when a sticky, fatty substance called plaque builds up on the inner lining of the arteries. The plaque may slowly narrow or even block the renal (kidney) artery.
Risk factors for atherosclerosis include high blood pressure, smoking, diabetes, high cholesterol, heavy alcohol use, cocaine abuse, and increasing age.
Fibromuscular dysplasia is another cause of renal artery stenosis. It is often seen in women under age 50 and tends to run in families. It is caused by abnormal growth of cells in the walls of the arteries leading to the kidneys. This also leads to narrowing or blockage of these arteries.
People with renovascular hypertension may have a history of high blood pressure that is severe and hard to control with medication.
Symptoms of renovascular hypertension include:
If you have a severe headache, nausea or vomiting, bad headache, confusion, changes in your vision, or nosebleeds you may have a severe and dangerous form of high blood pressure called malignant hypertension.
Signs and tests
The health care provider may hear a "whooshing" noise, called a bruit, when placing a stethoscope over your belly area.
The following blood tests may be done:
Imaging tests may be done to see if the kidney arteries have narrowed. They include:
High blood pressure caused by narrowing of the arteries that lead to the kidneys (renovascular hypertension) is often difficult to control.
Medications are needed 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. often more than one type may be needed.
Have your cholesterol checked and treated. If you have diabetes, heart disease, or hardening of the arteries somewhere else in your body, your "bad" (LDL) cholesterol should be lower than 100 mg/dL.
Lifestyle changes are important:
Further treatment depends on what causes the narrowing of the kidney arteries.Your doctor may recommend a procedure called angioplasty with stenting.
These procedures may be an option if you have:
However, experts are not certain which patients should have these procedures.
If your blood pressure is not well controlled, you are at risk for the following 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.
Preventing atherosclerosis or hardening of the arteries may prevent rental artery stenosis. You can do this by following these tips:
Victor RG. Systemic hypertension: Mechanisms and diagnosis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 45.
Kaplan NM. Systemic hypertension: Therapy. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 46.
Dworkin LD, Murphy T. Is there any reason to stent atherosclerotic renal artery stenosis? Am J Kidney Dis. 2010 Aug;56(2):259-63.
U.S. Preventive Services Task Force. Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2007;147(11):783-786.
Reviewed by:Melissa B Bleicher, MD, Division of Renal, Electrolyte, and Hypertension, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network, and David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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