What is renovascular hypertension (RVHT)?

Updated: Dec 01, 2020
  • Author: Rebecca J Schmidt, DO, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Renovascular hypertension (RVHT) reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular (ie, renovascular) disease and hypertension roughly defines this type of nonessential hypertension. [1] More specific diagnoses are made retrospectively when hypertension improves after intravascular intervention. [2]

At present, no sufficiently accurate, noninvasive, radiologic, or serologic screening test is available that, if negative, completely excludes the presence of renal artery stenosis (RAS). Current guidelines of the American College of Cardiology (ACC) and the American Heart Association (AHA) advocate screening for RAS only when a corrective procedure will be considered if renovascular disease is detected. [3]

When the history is highly suggestive and no risk of radiocontrast-mediated kidney injury is present renal arteriography is the appropriate test. When a moderate suspicion of renovascular disease exists, computed tomography angiograph (CTA), magnetic resonance angiography (MRA), or duplex ultrasonography should be considered for screening, the latter depending on availability and local experience.

Antihypertensive drug therapy is indicated. Optimal blood pressure control plays an essential role in the therapeutic management of RVHT; however, aggressive control of other risk factors for atherosclerosis also is crucial. Cessation of smoking is important for its positive impact on the cardiovascular risk profile in patients with hypertension. Similarly, antidyslipidemic therapy for those patients with hyperlipidemia likely provides benefit in atherosclerotic RVHT.

The invasive and surgical options for treatment of RVHT include percutaneous transluminal renal angioplasty (PTRA), surgical revascularization, and nephrectomy. Intravascular stents may be placed during angioplasty, although research has called the clinical benefit of this into question. (See Treatment.)

Patient education regarding hypertension should include information about the clinical features associated with RVHT (see Presentation) and about the importance of good blood pressure control. For patient education information, see What Is Renal Hypertension?.


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