Approach to Renovascular Hypertension

A BSTRACT The article describes the case of a 68-year-old man with poorly controlled hypertension, diabetes, and coronary artery disease, highlighting potential underlying causes of his condition, particularly secondary hypertension due to renal artery stenosis. His clinical evaluation reveals risk factors such as prolonged smoking, obesity, and peripheral vascular disease. Clinical examinations indicate significant blood pressure discrepancies between limbs and the presence of renal bruits, leading to the suspicion of renovascular hypertension. Resistant hypertension can often stem from renal causes, specifically atherosclerotic renal artery disease. Diagnostic approaches are detailed, including various imaging techniques and criteria for assessing renal artery stenosis. Management options are discussed, exploring both medical and interventional therapies. Although recent trials like ASTRAL, CORAL, and STAR showed limited benefits of revascularisation over medical management, selected patients may still benefit from intervention. The case underscores the importance of individualised patient evaluation for managing secondary hypertension and renovascular disease, considering both clinical presentation and renal parenchymal viability.