Table 3.

Clinical Approaches to Renovascular Hypertension Evaluation and Treatment

Cause	Patient characteristics	Risk factors	Screening, initial approaches	Confirmatory testing	Management options
Fibromuscular dysplasia	Female prevalence, age of onset 30s-50s, association with smoking, some with family history	Smoking	CT angiography MR angiography if CT not an option, Doppler US at specialized centers	Renal angiography	Angioplasty without stenting, rarely recurs vs medical therapy with renin-angiotensin blockade
Atherosclerotic disease	Male prevalence, older age of onset associated with atherosclerosis in multiple vascular beds, association with smoking, hyperlipidemia	CVD risk factors including smoking, hyperlipidemia	Doppler US CT or MR angiography	Renal angiography if intervention indicated	Unilateral disease: Medical therapy using renin-angiotensin blockade and management of CVD risk factors with interval monitoring of renal function and perfusion
					Bilateral disease: Medical therapy using renin-angiotensin blockade and management of CVD risk factors with interval monitoring of renal function and perfusion, vs angioplasty with stenting with careful assessment of risks of intervention
Aortic coarctation	Onset of hypertension prior to age 30 years, claudication symptoms	Bicuspid aortic valve	Measurement of brachial and popliteal BP CT angiography	CT angiography	Referral to congenital heart disease or vascular medicine specialist

CT, computerized tomography; CVD, cardiovascular disease; MR, magnetic resonance; US, ultrasound.