The potential impact of digital video subtraction angiography on screening for renovascular hypertension.

The success of digital video subtraction angiography (DVSA) in screening hypertensive patients for renal artery stenosis and the apparent value of percutaneous transluminal angioplasty (PTA) prompted re-evaluation of the philosophy of indiscriminate medical therapy for newly discovered cases of hypertension. DVSA was diagnostic in 87% of cases. The cost of screening for renovascular hypertension by DVSA and treatment by PTA when feasible is about the same as that of medical therapy. Considering the problems of noncompliance and drug side effects associated with medical antihypertensive therapy, DVSA screening for renovascular hypertension in a broader population seems both medically and economically sound.