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Renovascular hypertension

Renal hypertension; Hypertension - renovascular; Renal artery occlusion; Stenosis - renal artery; Renal artery stenosis; High blood pressure - renovascular

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.

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Hypertensive kidney
Renal arteries

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Causes

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, causing a condition known as atherosclerosis.

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.

Symptoms

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:

Exams and Tests

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:

Treatment

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 provider 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 provider may recommend a procedure called angioplasty with stenting.

These procedures may be an option if you have:

However, the decision about which people should have these procedures is complex, and depends on many of the factors listed above.

Possible Complications

If your blood pressure is not well controlled, you are at risk for the following complications:

When to Contact a Medical Professional

Call your provider if you think you have high blood pressure.

Call your provider if you have renovascular hypertension and symptoms get worse or do not improve with treatment. Also call if new symptoms develop.

Prevention

Preventing atherosclerosis may prevent renal artery stenosis. Taking the following steps can help:

Related Information

Hypertensive heart disease
Heart attack
Heart failure - overview
Injury - kidney and ureter
Acute kidney failure
Stroke
Blindness and vision loss

References

Siu AL, US Preventive Services Task Force. Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778-786. PMID: 26458123 www.ncbi.nlm.nih.gov/pubmed/26458123.

Textor SC. Renovascular hypertension and ischemic nephropathy. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 48.

Victor RG. Arterial hypertension. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 67.

Victor RG. Systemic hypertension: mechanisms and diagnosis. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 46.

Victor RG, Libby P. Systemic hypertension: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 47.

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Review Date: 6/10/2018  

Reviewed By: Deepak Sudheendra, MD, FSIR, RPVI, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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