Renovascular Hypertension: Causes, Symptoms, Treatment, Complications, Diagnosis

Renovascular hypertension is a medical condition in which there is a narrowing of the arteries in the kidney that is caused by an increase in blood pressure. This condition is also known as renal artery stenosis. Renovascular hypertension occurs when the arteries in the kidneys narrow down due to plaque formation that is composed of cholesterol and other fat substances.⁽¹⁾ Due to the plaque build-up in the arteries, much pressure is needed to move the blood through the arteries, which leads to renal hypertension. It is one of the most common type of secondary hypertension that is known to be caused by some underlying causes such as kidney disease and sleep apnea. Renovascular hypertension is a serious condition and can lead to resistant hypertension, a condition in which the blood pressure cannot be managed with at least three antihypertensive medications.

Renovascular hypertension can affect children as well. It can be managed with lifestyle adjustment and its complications can be avoided.

Renovascular stenosis is caused due to atherosclerosis of the renal arteries that has many risk factors associated, which include:

• Diabetes
• Smoking
• High blood pressure
• Increasing age
• Heavy alcohol abuse
• Cocaine abuse
• High cholesterol

Fibromuscular dysplasia is another condition that can lead to renal stenosis. It is caused due to abnormal growth of cells in the walls of the arteries, which narrows or blocks the arteries.

Renovascular hypertension does not show any symptoms unless it becomes a hypertensive emergency.

Symptoms of renovascular hypertension include:

• High blood pressure at a very young age.
• Kidneys not working well.
• Narrowing of the arteries in the body, such as legs, the brain, eyes, and elsewhere.
• Shortness of breath
• Nosebleed
• Anxiety
• Severe headache
• Changes in vision
• Nausea or vomiting

Renovascular hypertension can be controlled by hypertension medication.

Its diagnosis starts with physical examination and measuring blood pressure.

The heart and lungs are examined using a stethoscope, which sometimes catches the whooshing sound made by the blood flowing with pressure from the narrowed arteries.

If the doctor suspects renovascular hypertension, the following tests are ordered:

• Duplex ultrasound to look for the narrowed arteries.
• Computerized tomographic angiography in which multiple x-rays are taken and displayed on the computer screen for 3D manipulation.
• Magnetic resonance angiography to get detailed images of the kidney.
• Renal arteriography, an x-ray in which a dye is inserted into the bloodstream.

There are a few blood tests that can be performed:

• Cholesterol levels
• Blood urea nitrogen
• Potassium
• Creatinine clearance
• Renin and aldosterone levels

Similar to treating primary hypertension, renovascular hypertension treatment involves introducing lifestyle changes and a few medications.

Lifestyle changes involve:

• Limiting alcohol consumption
• Exercising regularly
• Eating a heart-healthy diet
• Quitting smoking
• Limiting the consumption of alcohol

Renovascular hypertension is diagnosed when a person has resistant hypertension, in which the body fails to respond to the normal blood pressure medications.

The medications commonly prescribed in renovascular hypertension are:

• Diuretics
• Angiotensin-converting enzyme
• Calcium channel blockers
• Angiotensin II receptor blockers

Revascularization is another option to treat narrowed arteries and restore the blood flow to the organs. A study done in 2020 suggested reserving revascularization for more serious conditions of hypertension in which other treatment options fail.⁽²⁾

Renovascular hypertension in children is also known as pediatric hypertension accounts for 5-25 percent of hypertension among children.⁽³⁾ A study conducted in 2021 found that treatment with a balloon catheter can be a good option for treating children with this condition.

Pediatric renovascular hypertension is often seen coinciding with other medical conditions such as:

• Alagille syndrome
• Neurofibromatosis
• Moyamoya disease
• William syndrome

Uncontrolled blood pressure can lead to the following complications, which include:

• Aortic aneurysm
• Vision problem
• Stroke
• Heart failure
• Heart attack
• Chronic kidney disease
• Poor blood supply

Renovascular hypertension is a lifelong condition but can be treated if detected early. It is important to work with a healthcare professional to take care of the heart, kidney, and wellbeing of other organs for a healthy and a disease-free life.