Which clinical history findings are characteristic of 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

The following are common findings from the history:

  • Onset of hypertension in patients younger than 30 years without risk factors

  • Abrupt onset of severe (stage II) hypertension (greater than 160/100 mm Hg in patients older than 55 years)

  • Severe or resistant hypertension despite appropriately dosed multidrug (>3 agents) antihypertensive therapy

  • Abrupt increase in blood pressure over previously stable baseline in patients with previously well-controlled essential hypertension, as well as patients with known renal artery stenosis (RAS)

  • Negative family history for hypertension

  • Smoking tobacco products

  • Acute sustained rise in serum creatinine levels with angiotensin-converting enzyme (ACE) inhibitor therapy

  • Unprovoked hypokalemia (serum potassium level < 3.6 mEq/L, often associated with metabolic alkalosis)

  • Symptoms of atherosclerotic disease at other sites, in the presence of moderate-to-severe hypertension, particularly in patients older than 50 years

  • Recurrent pulmonary edema in the setting of moderate-to-severe hypertension

  • Moderate-to-severe hypertension in a patient with an unexplained atrophic kidney, significantly asymmetric kidneys (> 1.5 cm difference), or diffuse atherosclerosis


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