What are the ACC/AHA recommended tests for renovascular hypertension (RVHT) screening?

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

Laboratory studies mentioned (see below) are often done for completeness and for historical context, and are not considered useful as screening tests. The clinical index of suspicion remains the primary determinant of the degree of evaluation that is indicated for RVHT.

As a screening test for RAS, the ACC/AHA guidelines recommend duplex ultrasonography. [3]  The advantages of duplex ultrasonography include lack of radiation, high sensitivity and specificity, low expense, and ability to be repeated without risk or discomfort to the patient. [22]   Disadvantages include that it is time consuming, operator-dependent and technically difficult in obese patients.

Other recommended screening tests include computed tomographic angiography (CTA), in patients with normal renal function, and magnetic resonance angiography. When the results of noninvasive screening tests are inconclusive and the clinical index of suspicion is high, angiography is recommended to establish the diagnosis of RAS. [3]  However, because of the risks associated with radiocontrast, angiography is imposed only on those individuals most likely to benefit.

Tests that are not recommended for RAS screening include captopril renal scintigraphy, selective renal vein renin measurements, plasma renin activity, and measurement of plasma renin activity after captopril administration (the captopril test). [3]

See Imaging in Renal Artery Stenosis/Renovascular Hypertension for a complete discussion of this topic.


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