Editing Renal Hypertension (section)

==== History and Physical Exam ====

* '''Most patients with renovascular hypertension present with moderate to severe hypertension'''
* '''Signs and symptoms of underlying possible renovascular disease and need for further evaluation if warranted (8):'''
*# '''Severe or refractory hypertension with evidence of''' grade III or IV '''hypertensive retinopathy''' (particularly in Caucasians)
*# '''Abrupt onset of moderate to severe hypertension''', particularly in a normotensive or previously well-controlled hypertensive
*# '''Onset of hypertension before age 20''' (early onset) or after age 50 (late onset), particularly in those without a family history of hypertension
*# '''Unexplained worsening of renal function (with or without hypertension) in association with the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs)''' or with a reduction of blood pressure to the current accepted norm with the use of other antihypertensive agents
*# '''Paradoxic worsening of hypertension with the use of diuretics'''
*# Unexplained recurrent episodes of heart failure—“flash” pulmonary edema
*# The presence of a systolic-diastolic abdominal bruit that radiates to both flanks
*# The presence of diffuse vascular disease and/or evidence of cholesterol embolization