Renovascular hypertension is the most common correctable cause of secondary hypertension and should be suspected in patients with clinical clues suggestive of renovascular disease. Renal artery stenosis (RAS) is present in about 1% of patients with mild hypertension, in up to 45% of Caucasian patients with severe hypertension, and in 25%-35% of patients with peripheral arterial disease (as in this patient with reduced peripheral pulses). Such patients should have noninvasive assessment with renal duplex Doppler ultrasonography or CT or MR angiography (MRA) for the diagnosis of RAS. Renal Doppler ultrasound is the initial preferred modality in patients with renal insufficiency due to risk of contrast-induced nephropathy (with CT angiography) and nephrogenic systemic fibrosis (with gadolinium-enhanced MRA). Noncontrast MRA may be performed when available.
