Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with resistant hypertension despite adherence to a 3-drug regimen including a diuretic. Reports recent onset of accelerated blood pressure readings. Denies chest pain or dyspnea. Significant history of peripheral vascular disease, smoking, or sudden worsening of renal function following initiation of ACE inhibitor/ARB therapy.
Clinical Examination Findings
Cardiovascular: S1/S2 present, no murmurs. Abdominal: Presence of a localized epigastric or flank bruit on auscultation. Extremities: Pulses symmetric, no evidence of edema. Funduscopic: Grade II-III hypertensive retinopathy noted.
Treatment Protocol
Initiate diagnostic workup with Renal Artery Duplex Ultrasound or CT Angiography. Pharmacotherapy: Optimize blood pressure control; exercise caution with ACE inhibitors/ARBs if bilateral renal artery stenosis is suspected. Consider referral for renal artery revascularization (stenting) if hemodynamically significant stenosis is confirmed.