Diagnosis of Renal Hypertension

SINCE the work of Goldblatt, Lynch, Hanzal and Summervillle in 1934 on the production of persistent hypertension in dogs there has been sustained interest in investigating hypertensive patients from the point of view of demonstrating a renal lesion, the surgical treatment of which might lead to permanent relief of hypertension. Many lesions of the kidney have been found -to be associated with hypertension and with wider use of renal arteriography, the importance of renal artery occlusive disease as an etiological factor in hypertension has been amply demonstrated. (Howard, Berthrong, Sloan and Yendt, 1953; Poutasse, Humphries, M&dormack and Corcoran, 1956; De Camp and Birchall, 1958; Brown, Owen, Peart, Robertson and Sutton, 1962). Smith (1956) estimated that between i to 2 per cent of all hypertensive patients have surgically correctable renal lesions, and recent estimates (Sutton, Brunton and Starer, 1960; Maxwell and Prozan, 1962) indicate that this figure may 'be as high as 10 per cent. Essential hypertension and reno-vascular hypertension are often clinically indistinguishable (Maxwell, 1962; Wilson, Dustan, Page and Poutasse, 1963) but an underlying renal cause for hypertension may be suspected in the following circumstances: 1. Hypertension of recent onset at any age, particularly if rapidly progressive. 2. Hypertension in a young patient with no family history of high blood pressure. 3. A sudden increase in the blood pressure in a patient known to have essential hypertension. 4. A previous history of abdominal or loin pain, of renal trauma or of peripheral arterial emboli. 5. When a bruit is heard on auscultation over the -renal area. Diagnostic studies that may be useful in investigating patients selected by are: such criteria