Renovascular Hypertensionand Plasma Renin Activity1

This 25-year-old white man was admitted to Barnes Hospital for evaluation of long-standing progressive hypertension. He had a 15-year history of hypertension, which apparently had been evaluated at age 10, at which time no specific etiology was found. Blood pressure had been fairly well controlled on several drugs, but during the past year it had become increasingly difficult to control, ranging from 150/1 10 mmHg to 190/130 mmHg. At the time of admission, he was receiving the following antihypertensive medications: methyldopa, 1.0 g daily; propranolol, 480 mg daily; and hydrochlorothiazide, 100 mg daily. His family history indicated hypertension and heart disease in parents, grandparents, and siblings. At admission, the blood pressure was 170/1 10 mmHg and retinal examination revealed arteriosclerotic changes. No abdominal bruit was noted and the rest of the physical examination was unremarkable. Laboratory data at admission included normal values for sodium, potassium, chloride, creatinine, serum urea nitrogen, aspartate aminotransferase (BC 2.6.1.1), lactate dehydrogenase (EC 1.1.1.27), creatine kinase (BC 2.7.3.2), bilirubin, glucose, total protein, leukocyte count, hemoglobin, and urinalysis. The chest roentgenogram was normal and the electrocardiogram revealed left ventricular hypertrophy with minor, nonspecific changes. Intravenous pyelography was normal, but isotopic renal scan showed focal retention of media in the upper pole of the left kidney, with the left and right kidneys contributing 44 and 56% of total renal function,