Detection of Renovascular Hypertension

PURPOSE: To review recent advances in detecting renovascular hypertension. DATA SOURCES: Original English-language reports obtained through a MEDLINE search for the years 1987 to 1991. Also, a manual search through Index Medicus as well as bibliographies of original reports and selected review articles. STUDY SELECTION AND DATA EXTRACTION: Cited studies were critically reviewed with emphasis on study size, patient sample, methods, diagnostic criteria, and reproducibility of results. Where applicable, reviews that combined the results of smaller studies are cited. RESULTS: A sensitivity of 74% and a specificity of 89% have been reported for the captopril test and of 93% and 95%, respectively, for captopril scintigraphy with diethylenetriaminepentaacetic acid (DTPA). The sensitivity and specificity of renal vein renin determination are 80% and 62%, respectively and may increase with the use of stricter technical criteria and maneuvers to stimulate renin secretion. These tests differentiate renovascular hypertension from essential hypertension more reliably than from asymmetric renal parenchymal disease; however, they do not reliably distinguish unilateral from bilateral stenosis. Other tests are less widely used. Intravenous pyelography (sensitivity, 74.5%; specificity, 86.2%) has the disadvantages of radiation and dye load exposure. Intravenous angiography is expensive and invasive and does not always enable visualization of the origin of the renal artery. The roles of duplex ultrasound and magnetic resonance angiography remain to be clarified. CONCLUSIONS: Noninvasive tests are cost effective and have a high predictive value in patients with clinical clues suggestive of renovascular hypertension. These tests are not recommended for use in patients with a low likelihood of disease.