Which physical 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

Findings suggestive of long-standing hypertension may or may not be evident upon physical examination. Such findings may include the following:

  • Recurrent flash pulmonary edema or unexplained episodes of congestive heart failure

  • Advanced funduscopic changes

  • Abdominal bruit – A clear abdominal bruit may be heard in 46% of patients with RVHT, however, innocent bruits are common in younger individuals; systolic-diastolic bruits in combination with hypertension are suggestive of RVHT

On physical examination, pediatric patients with RVHT have a blood pressure elevation above the 95th percentile for their age, sex, and height. Generally, children with blood pressures higher than 140/100 mm Hg are thought to be more likely to have secondary hypertension, and RVHT is more likely in children with higher blood pressure. [15, 19]

Eye examination may reveal retinopathy and retinal hemorrhages. Patients with heart failure may present with tachypnea, cardiomegaly, and vasomotor instability leading to mottling and acrocyanosis. Lower-extremity pulses may be diminished with aortic coarctation, whether thoracic or abdominal.

An enlarged liver may be palpated, and an abdominal bruit may be auscultated. Patients with tumors impinging on renal vasculature may present with an abdominal mass in the area of the kidney. Rarely, signs or symptoms of visceral artery involvement are present because of the extensive collateralization that occurs.

Café-au-lait macules are classic findings in the presentation of neurofibromatosis. Patients with neurofibromatosis may also have macrocephaly, neurofibromas, dermal neurofibromas, and axillary freckling.


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