People with hypertension who present with two or more of the following:
should be investigated for renovascular hypertension.
Leung AA, Nerenberg K, Daskalopoulou SS, et al. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol. 2016; 32(5): 569-588. doi: 10.1016/j.cjca.2016.02.066.
Patients presenting with >= 2 of the following clinical clues, suggesting renovascular hypertension, should be investigated (Grade D):
i. Sudden onset or worsening of hypertension and age >55 or < 30 years;
ii. Presence of an abdominal bruit;
iii. Hypertension resistant to >= 3 drugs;
iv. Increase in serum creatinine level >= 30% associated with use of an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB);
v. Other atherosclerotic vascular disease, particularly in patients who smoke or have dyslipidemia;
vi. Recurrent pulmonary edema associated with hypertensive surges.
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, and computed tomography (CT) angiography (for those with normal renal function) (Grade B). Captopril-enhanced radioisotope renal scan is not recommended for those with chronic kidney disease (glomerular filtration rate<60mL/min/1.73m2) (Grade D).