Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of refractory hypertension. History significant for early-onset hypertension, often resistant to multi-drug regimens. Patient denies symptoms of secondary HTN causes but reports occasional headaches or pulsatile tinnitus. No history of tobacco use. Family history negative for early-onset cardiovascular disease.
Clinical Examination Findings
Cardiovascular exam reveals a high-pitched abdominal bruit, typically localized to the epigastrium or flank, suggesting renal artery stenosis. Blood pressure measurements are elevated and discordant between limbs if associated with subclavian involvement. Peripheral pulses are symmetric; no signs of congestive heart failure.
Treatment Protocol
Management plan includes initiation of ACE inhibitors or ARBs for blood pressure control, provided renal function is stable. Referral for renal artery revascularization (percutaneous transluminal angioplasty) is indicated if hypertension remains refractory or if there is evidence of progressive renal insufficiency. Regular monitoring of serum creatinine and electrolytes is required.