Optimizing Work-up of Adult Hypertensive Patients for Renal Artery Stenosis: Observations About Hypertensive Urography, Digital Subtraction Arteriography, and Patient Selection

Abstract

To put it simply, one should not use arteriography to screen all hypertensive patients (or even those with moderate to severe hypertension) for the diagnosis of renovascular disease and then decide whether or not to do surgery for renovascular hypertension. Rather, one should select that patient subpopulation with clinical findings that indicate a high likelihood of successful surgical correction of hypertension due to renal artery stenosis. It is among these patients that it is most productive to do digital arteriography and renal vein renin sampling. Thus, the indications for selection of patients for digital arteriography and renal vein renin sampling are the same indications that are used for surgery of renal artery stenosis. Linking patient selection for use of the diagnostic test to the treatment choice is the basis for our recommended strategy. Using digital arteriography as a screening test in other than highly selected hypertensive patients puts a large number of patients at risk and incurs great expense for no good purpose.