V. Assessment for Renovascular Hypertension
1) Patients presenting with two or more of the following clinical clues listed below suggesting renovascular hypertension should be investigated (Grade D).
- sudden onset or worsening of hypertension and age older than 55 years or younger than 30 years;
- the presence of an abdominal bruit;
- hypertension resistant to three or more drugs;
- a rise in creatinine of 30% or more associated with use of an angiotensin-converting enzyme inhibitor or angiotensin II receptor antagonist;
- other atherosclerotic vascular disease, particularly in patients who smoke or have dyslipidemia; and
- recurrent pulmonary edema associated with hypertensive surges.
2) When available, the following tests are recommended to aid in the usual screening for renal vascular disease: captopril- enhanced radioisotope renal scan, Doppler sonography, magnetic resonance angiography, computed tomographic angiography (for those with normal renal function) (Grade B). Captopril-enhanced radioisotope renal scan is not recommended for those with CKD (GFR < 60 mL/min/1.73 m) (Grade D).