Diagnosing renovascular hypertension

Diagnosing renovascular hypertension is complex. Definitive diagnosis can o nly be made in retrospect, when a hypertensive patient with renal artery st enosis improves following correction of the stenotic arterial lesion. Scree ning for renovascular hypertension in all hypertensive patients is impracti cal because of the low prevalence of the disease. However, the diagnosis is important because treatment can lead to potential cure. A select group of patients with clinical signs and symptoms suggesting renovascular hypertens ion need to be investigated further for the cause of their hypertension. A number of clinical tests help in screening patients that require further im aging tests. The tests designed for evaluating renovascular hypertension as sess the functional and anatomic abnormalities. This article reviews variou s clinical and imaging techniques available for evaluating these patients. A description of each technique is followed by a discussion of its advantag es and disadvantages. The authors also propose an algorithm for work-up of patients with a high probability of renovascular hypertension.