Hypertensive vascular crisis secondary to chronic total renal artery occlusion

We have reviewed thirty-three cases of accelerated hypertension associated with chronic total renal artery occlusion. During the process of progressiv e narrowing of the arterial lumen until complete occlusion, an exceptionall y elevated blood pressure occurs when a critical reduction of renal blood f low is attained. Then the patient presents one or more of the following cli nical manifestations: III-IV grade KWB retinal changes, hypertensive enceph alopathy including convulsive attacks, stroke, heart failure, renal insuffi ciency. We have called this clinical event 'hypertensive vascular crisis'. Mostly i n older patients an actual or anamnestic vascular crisis makes a diagnosis of chronic total renal artery occlusion highly probable.