Background: In foreign literature, 90% of renal artery stenosis (RAS) is atherosclerotic, while 10% is secondary to fibromuscular dysplasia (FMD). However, an important differential for hypertension in the young Asian population is Takayasu’s arteritis. We present four patients who initially presented with hypertension in the young due to RAS. Clinical criteria coupled with non-invasive studies in all four cases led to the diagnosis of Takayasu’s arteritis. All four patients had good outcomes. Case: Four patients (one male and three females) all presented with early-onset hypertension in the third decade of life. Two of the females were pregnant at the time they were seen by the Cardiology service at our institution. Physical examination of the abdomen and peripheral pulses provided clinical clues that suggested the diagnosis of Takayasu’s arteritis. All four patients had confirmed significant RAS on CT aortogram studies, thus explaining their elevated blood pressures. None of them had significant elevations in serum creatinine. The patients were given varying combinations of anti-hypertensive medications with or without prednisone to control vasculitic flares/disease activity. All four patients had good outcomes. The two pregnant in-patients were successfully discharged after their emergency cesarean sections, and all four went on regular follow-up at the outpatient clinic with controlled blood pressure levels. Significance: This case series highlights that with the rarity of Takayasu’s arteritis, a thorough history and and conclusions physicalexamination are crucial in raising our index of suspicion for this disease as a possible cause of RAS and secondary hypertension. This report also emphasizes the complexity of managing pregnant patients with Takayasu’s arteritis. Early recognition, a multidisciplinary team, and optimal medical management are the keys to successful outcomes. Keywords: renal artery stenosis, Takayasu’s arteritis, secondary hypertension, vasculitis.