Similar prevalence of renovascular hypertension in selected blacks and whites.

Abstract

Renovascular hypertension is a potentially curable form of high blood pressure that is thought to be extremely rare among blacks. We demonstrate, however, that in a clinically selected population, the prevalence of renovascular hypertension is similar in blacks and whites. We prospectively evaluated 167 hypertensive subjects who had one or more clinical features known to be associated with renovascular hypertension. All subjects had captopril-stimulated peripheral renin measurements and conventional renal arteriography. All significant renal artery stenoses (greater than 50% luminal narrowing) were treated with percutaneous transluminal angioplasty or surgery. Renovascular hypertension was diagnosed if there was a blood pressure response to interventional therapy, according to the criteria established by the Cooperative Study of Renovascular Hypertension. Of the total group evaluated, 24% (39 of 167) had renal artery stenosis and 14% (23 of 167) had renovascular hypertension. Renal artery stenosis or occlusion was found in 27% (26 of 97) of whites and 19% (13 of 67) of blacks (p=027). Renovascular hypertension was diagnosed in 18% (17 of 97) of whites and 9% (6 of 67) of blacks evaluated (p=0.25). Renovascular hypertension was associated with severe or refractory hypertension and with smoking, but there were no racial differences in these associations. Blacks with renovascular hypertension tended to have low captopril-stimulated peripheral renin activity. We conclude that blacks with clinical features suggestive of renovascular hypertension should be evaluated with angiography. Captopril-stimulated plasma renin may not be useful in detecting blacks with renovascular hypertension, but this and other potential screening tests require further evaluation. (Hypertension 1991;17:678-683) R enovascular hypertension is a potentially curable form of high blood pressure that is thought to be extremely rare among blacks. "3 There is a clear association, however, between renovascular hypertension and extreme elevations in blood pressure. 4-5 The high prevalence of severe hypertension among blacks suggests that this subgroup may have a high prevalence of reversible hypertension. In addition, other clinical features found to be associated with renovascular disease in whites have not been adequately evaluated in blacks. There is no previous report of racial differences in renovascular hypertension in which the diagnosis was made or excluded conclusively based on angiography and response to interventional treatment. We demonstrate that in a clinically selected population, the prevalence of renovascular hypertension is similar in blacks and whites. MethodsAmbulatory hypertensive adults were recruited from the Duke Hypertension Center and the Durham Veterans Affairs Medical Center Hypertension Clinic. Blacks comprise 40% of the combined populations of these two clinics. The diagnosis of hypertension was confirmed if untreated systolic blood pressure was greater than 145 mm Hg or diastolic blood pressure was greater than 90 mm Hg ...

The prevalence of atherosclerotic renal artery stenosis in risk groups: a systematic literature review

“…Table 1 [4,8,10, summarizes characteristics and RAS prevalence data of the individual studies. Contrast-enhanced arteriography served as the reference method for detection of RAS in 35 studies.…”

“…Therefore, in the risk group with hypertensive patients, a distinction between these two pathogenic causes of RAS was made in cases it was possible. Figure 1 [4,8,10,[12][13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39][40][41][42][43][44][45][46][47][48][49] provides an overview of pooled prevalence rates of RAS in nine risk group categories. The overall pooled prevalence rate in these risk groups was 15.4% (95% CI 14.8-15.9%).…”

“…In patients with clinical characteristics suggestive of renovascular hypertension (such as severe hypertension, therapyresistant hypertension, onset of hypertension on a young age, recent onset hypertension or an abdominal bruit) six angiographic studies have been performed [10,[12][13][14][15][16]. RAS prevalence in these studies ranged from 10.4 to 20.3%, with a pooled prevalence rate of 14.1% (95% CI 12.7-15.8%).…”

“…It is, therefore, important to identify those patients who are at increased risk of having a significant RAS, and this requires insight in the epidemiology of RAS in risk groups. Previous studies in patients with hypertension, diabetes mellitus, cardiovascular diseases and end-stage renal failure have suggested a high prevalence of RAS in these groups [3][4][5][6][7][8][9][10][11]. However, variation in used methodology across studies and the relatively small sample size of most series hamper the interpretation and generalizability.…”

Renal Artery Stenosis in Minority Patients Undergoing Diagnostic Cardiac Catheterization: Prevalence and Risk Factors

“…On the other hand, the data regarding RAS in African Americans are conflicting. Several studies have highlighted the rarity of RAS in African Americans (22)(23)(24)(25)(26), while others have suggested no significant difference in the prevalence of RAS among selected populations of African American patients and white patients (27).…”