Renovascular Hypertension

ExitCare ImageRenovascular hypertension is high blood pressure that is caused by a narrowing of the arteries that carry blood to the kidneys (renal arteries).

Complications from renovascular hypertension can lead to:

  • Heart failure.

  • Heart disease.

  • Stroke.

  • Kidney failure

  • Blood vessel damage.

  • Blindness.

CAUSES

Renovascular hypertension occurs when one or both of the renal arteries become narrow. This narrowing reduces blood flow to the kidneys, which makes the kidneys think blood pressure is low. As a result, they make an enzyme called renin. Renin tells the body to keep in salt and water rather than letting it leave the body as urine. This causes an increase in blood pressure.

There are numerous conditions that can cause renovascular hypertension. Some of these are:

  • Atherosclerosis. This is a hardening of the renal arteries. It causes plaque to build up and block the renal arteries.  

  • Fibromuscular dysplasia. This is a condition in which cells of the artery wall overgrow, causing a narrowing of the renal arteries.  It is a common cause of renovascular hypertension in younger women.  

  • A blockage in the renal artery due to injury, tumors, or blood clots (rare).

RISK FACTORS

Renovascular hypertension is more common in women younger than 30 years and men older than 50 years.

SIGNS AND SYMPTOMS

There are often no symptoms. If symptoms are present, they may include:

  • Sudden high blood pressure that gets worse in older persons with previously well controlled blood pressure.  

  • Nausea and vomiting.  

  • Problems with vision.  

  • Chest pain.  

DIAGNOSIS

Renovascular hypertension is often suspected during a routine exam or blood pressure check. Your health care provider may use a stethoscope to listen for a "whooshing" noise over the abdominal or flank area (bruit). Tests to diagnose renovascular hypertension include:

  • Blood tests. These are done to look at your hormone levels. Tests may also be done to measure renin and aldosterone levels. Aldosterone is a hormone that controls the salt and water balance in your body.  

  • Imaging tests. These may include:

  • An ultrasound. This is a test that uses sound waves to produce an image of the inside of your body.

  • Renal angiography. This is a test in which a dye is injected into a kidney artery to show narrowing of the artery on an X-ray.

  • MRI of the arteries supplying the kidneys.

TREATMENT

  • Medicines. These may be given to help you control your blood pressure.  

  • Treatment of any condition causing the high blood pressure. This may mean lowering your cholesterol, eating a heart-healthy diet, exercising, and maintaining an ideal body weight.  

  • Surgery to remove a blockage. This may be necessary if a renal artery is blocked badly.  

  • Percutaneous transluminal angioplasty (PTRA). This is a procedure to open narrow renal arteries if they are not completely blocked. Sometimes a stent is placed in the artery to prevent the artery from becoming blocked again.

HOME CARE INSTRUCTIONS

  • Take medicines as directed by your health care provider.  

  • Maintain an ideal body weight.  

  • Eat a heart-healthy diet. This includes:

  • Managing your cholesterol levels.

  • Controlling your salt (sodium) intake. This can lower your blood pressure. Avoid eating foods high in sodium, such as processed meats, MSG, and baking soda.

  • Exercise regularly.  

  • Stop smoking if you smoke.  

  • Avoid drinking alcohol. Your health care provider can help you determine how much alcohol is safe for you to drink.  

  • Monitor your blood pressure.

Monitoring Your Blood Pressure  

A blood pressure reading is recorded as two numbers, such as 120 over 80 (or 120/80). The first, higher number is called the systolic pressure. Generally, this number should be under 130. The second, lower number is called the diastolic pressure. It should be below 90.

Keeping your blood pressure in a normal range is important to your overall health and prevention of health problems, such as heart disease and stroke. When your blood pressure is uncontrolled, your heart has to work harder than normal.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop shortness of breath.  

  • You develop numbness on one side.  

  • You develop areas of muscle weakness.  

  • You are unable to speak.

  • You feel lightheaded or pass out.  

  • You have sudden elevations of blood pressure.  

  • You have symptoms of very high blood pressure.