Detection, Evaluation, and Treatment of Renovascular Hypertension

• Careful interpretation of clinical clues continues to provide valuable information to identify patients in whom further evaluation for renovascular hypertension (RVH) is needed. Newer diagnostic techniques such as intravenous digital subtraction angiography and computer-generated renal flow scans have helped to more accurately identify patients in whom renal arteriography is indicated. More sensitive and specific tests are still needed to establish the hemodynamic significance of renal artery lesions. New classes of antihypertensive drugs, particularly β-blockers and angiotensin-converting enzyme inhibitors, have enabled the control of blood pressure in most patients with RVH but do not assure preservation of renal function. An aggressive search for and correction of coexisting risk factors, and improved surgical techniques, have resulted in lower surgical mortality. The development of percutaneous transluminal renal angioplasty has provided an invasive, nonsurgical method for managing RVH in selected patients. (Arch Intern Med1987;147:820-829)