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Renovascular hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys. This condition is also called renal artery stenosis.
Renal hypertension; Hypertension - renovascular; Renal artery occlusion; Stenosis - renal artery; Renal artery stenosis
Renal artery stenosis is a narrowing or blockage of the arteries that supply blood to the kidneys.
The most common cause of renal artery stenosis is a blockage in the arteries due to high cholesterol. This problem occurs when a sticky, fatty substance called plaque builds up on the inner lining of the arteries.
When the arteries that carry blood to your kidneys become narrow, less blood flows to the kidneys. The kidneys mistakenly respond as if your blood pressure is low. As a result, they release hormones that tell the body to hold on to more salt and water. This causes your blood pressure to rise.
Risk factors for atherosclerosis:
Fibromuscular dysplasia is another cause of renal artery stenosis. It is often seen in women under age 50. It tends to run in families. The condition is caused by abnormal growth of cells in the walls of the arteries leading to the kidneys. This also leads to narrowing or blockage of these arteries.
People with renovascular hypertension may have a history of very high blood pressure that is hard to bring down with medicines.
Symptoms of renovascular hypertension include:
If you have a dangerous form of high blood pressure called malignant hypertension, symptoms can include:
The health care provider may hear a "whooshing" noise, called a bruit, when placing a stethoscope over your belly area.
The following blood tests may be done:
Imaging tests may be done to see if the kidney arteries have narrowed. They include:
High blood pressure caused by narrowing of the arteries that lead to the kidneys is often hard to control.
One or more medicines are needed to help control blood pressure. There are many types available.
Have your cholesterol levels checked, and treated if it is needed. Your doctor will help determine the right cholesterol levels for you based on your heart disease risk and other health conditions.
Lifestyle changes are important:
Further treatment depends on what causes the narrowing of the kidney arteries. Your doctor may recommend a procedure called angioplasty with stenting.
These procedures may be an option if you have:
However, the decision about which patients should have these procedures is complex, and depends on many of the factors listed above.
If your blood pressure is not well controlled, you are at risk for the following complications:
Call your health care provider if you think you have high blood pressure.
Call your health care provider if you have renovascular hypertension and symptoms get worse or do not improve with treatment. Also call if new symptoms develop.
Preventing atherosclerosis may prevent rental artery stenosis. Taking the following steps can help:
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Kaplan NM. Systemic hypertension: Therapy. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 46.
Textor SC. Renovascular Hypertension and Ischemic Nephropathy. In: Taal MW, Chertow GM, Marsden PA et al. eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 47.
Dworkin LD, Murphy T. Is there any reason to stent atherosclerotic renal artery stenosis? Am J Kidney Dis. 2010 Aug;56(2):259-63.
U.S. Preventive Services Task Force. Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2007;147(11):783-786.
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