An 80-year-old woman was brought to the emergency department with acce
lerated hypertension. Multiple medical regimens failed, including an a
ngiotensin-converting enzyme inhibitor, which caused acute renal failu
re. Results of a renal scan for captopril were negative; renal arterio
gram revealed fibromuscular dysplasia of the right renal artery. Percu
taneous transluminal angioplasty was successful in dilating the renal
artery and making blood pressure easier to control. Although more comm
on in younger people, fibromuscular dysplasia should be considered in
patients who are elderly and have hypertension that is difficult to co
ntrol. Transluminal angioplasty should be attempted to preserve renal
function and control blood pressure.