Renovascular hypertension is usually caused by narrowed arteries in the kidneys that cause a significant increase in blood pressure. Many times, you may not experience symptoms.

It’s a serious condition that often contributes to resistant hypertension — high blood pressure that can’t be managed with at least three antihypertensive medications.

While it’s much more common in adults, renovascular hypertension can affect children, too. But with proper treatment and lifestyle adjustments, renovascular hypertension — and its potential health complications — can be managed effectively.

Renovascular hypertension is also known as renal hypertension. It’s a type of high blood pressure that starts in the kidneys.

When your blood pressure climbs too high, it can multiple health complications. A blood pressure of 130/80 mm Hg or higher is considered hypertension.

Renovascular hypertension usually occurs when the arteries in the kidneys become narrow due to plaque forming along the artery walls. Plaque is composed of cholesterol, fat, and other substances. With a narrower channel in the renal arteries, the pressure needed to force blood through the arteries increases, and renovascular hypertension is the result.

Renovascular hypertension is one of the main types of secondary hypertension, which is different from primary hypertension. Primary hypertension has no singular identifiable cause and usually develops slowly over the years. Secondary hypertension has a specific underlying cause, such as kidney disease or sleep apnea.

Renovascular hypertension, as well as other types of high blood pressure, usually don’t cause noticeable symptoms unless it has become a hypertensive emergency. A hypertensive emergency is defined as a blood pressure of 180/120 mm Hg or higher.

In cases of extremely high blood pressure, symptoms can include:

  • severe headache
  • shortness of breath
  • anxiety
  • nosebleed

Other signs that may alert a healthcare professional to renovascular hypertension include:

  • sudden high blood pressure before age 30 or after age 55
  • high blood pressure that worsens while you’re on antihypertensive therapy
  • high blood pressure and blood tests that show poor kidney function

Renovascular hypertension isn’t typically a condition that doctors look for without a reason.

If you have high blood pressure that can’t be easily controlled with one or two antihypertensive medications, your doctor may start to look for a cause such as renovascular hypertension. Similarly, high blood pressure accompanied by kidney problems should prompt a similar search.

A diagnosis of renovascular hypertension starts with a physical exam and a check of your blood pressure.

A healthcare professional should use a stethoscope to listen to your heart and lungs, as well as your abdomen. Sometimes a stethoscope can pick up the distinct whooshing sound (called a bruit) made by blood flowing through a narrowed artery.

If renovascular hypertension is suspected, one or more of the following imaging tests may be ordered:

  • duplex ultrasound to reveal any narrowed or blocked arteries in the kidneys
  • computerized tomographic angiography (CTA), which takes multiple layers of X-rays and display them on a computer screen, where they can be manipulated in 3D
  • magnetic resonance angiography (MRA), which uses a magnetic field and radio waves to create detailed images of the kidneys and injected contrast dye to highlight circulation in the kidney’s blood vessels
  • renal arteriography, which is a special type of X-ray that also relies on a dye injected into your bloodstream

If you’re going to be tested for renovascular hypertension, be prepared to have your blood pressure checked at your appointment. If you have been monitoring your own blood pressure, share your recent results, especially if they have significantly changed.

You may also have blood tests to look for signs of kidney disease or other markers that could indicate renovascular hypertension. Due to the nature of the condition, imaging is also often necessary to make an accurate diagnosis, as discussed above.

In addition to having some imaging test done, you might also ask your doctor the following questions:

  • What can I do to get my blood pressure under control?
  • How often should I check my blood pressure at home?
  • What is my target blood pressure?
  • Are my kidneys functioning normally?
  • Do I have renal artery stenosis?

The treatment for renovascular hypertension is very similar to those for primary hypertension. Initially, it involves lifestyle changes and medications.

Among the lifestyle adjustments that may help are:

  • eating a heart-healthy diet low in sodium, saturated fats, and added sugars
  • exercising all or most days of the week
  • maintaining a healthy weight
  • limiting alcohol consumption
  • not smoking
  • getting 7 to 8 hours of sleep per night
  • managing stress

Medications can also be helpful, though you may need more than one to keep your blood pressure under control. In many cases, renovascular hypertension is discovered when a person has resistant hypertension that hasn’t responded to the usual blood pressure medications.

Commonly prescribed medications for renovascular hypertension include:

  • angiotensin-converting enzyme (ACE) inhibitors
  • angiotensin II receptor blockers (ARBs)
  • calcium channel blockers
  • diuretics

Another option to treat narrowed arteries is called revascularization, which means restoring blood flow to a particular organ.

This is often done with a catheter fitted with a small balloon, that is inflated when the catheter tip reaches the area of blockage in the artery. The balloon pushes plaques against the inner walls of the artery, widening the channel for blood flow. In some cases, a stent is left behind to keep the artery open.

A 2020 study and previous research suggest that revascularization should be reserved for more serious cases of renovascular hypertension and those in which previously well-controlled high blood pressure has suddenly become more difficult to manage.

Pediatric renovascular hypertension is a rare condition, but it does account for about 5 to 25 percent of hypertension cases among children.

Data from a 2021 study suggests that treatment with a balloon catheter and/or stent can be considered as a treatment option in children with this condition. However, they note that until more research is available, only medical centers with expertise in this area should perform such procedures.

Having your child evaluated at a medical center that specializes in treating pediatric cardiovascular conditions could lead to a faster, more accurate diagnosis and treatment by healthcare providers familiar with this disease.

Pediatric renovascular hypertension often coincides with other medical conditions. Among them are:

Renovascular hypertension is a lifelong condition, but it can usually be effectively treated once detected.

You’ll probably need to take medications to manage it, and a healthy lifestyle could also result in fewer medications to keep your blood pressure in a healthy range.

If further narrowing of your renal arteries occurs, you may have a revascularization procedure.

If you’d like to share your experience with others who know what you’re going through, consider joining a support group like the Renal Support Network.

By working with healthcare professionals and taking care of your heart, kidneys, and mental well-being, this condition shouldn’t prevent you from living a long, fulfilling life.