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PrevalenceThe prevalence of RAS increases with the age and in patients with known cardiovascular risk factors such as diabetes, hypertension, and dyslipidemia. The prevalence of RAS of >70% was 7.3% in patient who has undergone cardiac catheterization with resistant hypertension, renal impairment, flash pulmonary edema, or atherosclerosis in other vascular territories. [1] In our study, [2] the incidence of RAS was 7.7% by the routine drive-by angiogram, during coronary angiography for suspected CAD. In the general population, 2-5% of secondary hypertension is due to ARAS. In autopsy series, 27% had RAS of >50% in the group aged >50 years. AbstractRenovascular Hypertension (RVH) is the most common cause of secondary hypertension. High index of suspicion is needed to diagnose this condition. Two major causes for RVH are renal artery stenosis (RAS) secondary to atherosclerosis (~90%) and fibromuscular dysplasia (~10%). Certain clinical clues for RVH are unprovoked hypokalemia, abdominal bruit, age of the onset of hypertension (<30 years or >55 years), the absence of the family history of hypertension, recent onset of hypertension (duration <1 year), difference of kidney size >1 cm, unexplained azotemia, recurrent flash pulmonary oedema, new onset azotemia with initiation of ACEI, and resistant or refractory hypertension. Revascularization by Percutaneous transluminal renal angioplasty (PTRA)/surgery as indicated should be instituted whenever there is medical failure or worsening of azotemia with maximal medical therapy for RVH.