The detection of renovascular hypertension: a study of 490 patients by renal angiography.

Four hundred and ninety patients with hypertension were studied to determine those clinical characteristics or simple investigations that predict the presence of operable renal artery stenosis on renal angiography. One hundred and fifty two of the 490 patients were below the age of 40, had a good response to treatment, a normal physical examination, normal renal function, and normal intravenous pyelogram. Only one of the 152 patients had an operable renal artery lesion. Of the remaining 338 patients, 168 had a normal angiograms, 50 had surgically correctable renal artery stenosis, 75 had renal artery narrowing of less than 70 per cent and 45 patients had significant parenchymal renal disease. Abnormal renal angiograms were found significantly (p less than 0.05) more often in patients with poor control of blood pressure, impaired renal function or a history of antipyretic analgesic abuse. Our experience in hypertensive patients suggests that renal arteriography is unlikely to provide useful information in patients under 40 years old, but may well demonstrate a remediable abnormality in older patients with poor control of hypertension associated with a history of antipyretic analgesic abuse and/or impaired renal function.