Renovascular hypertension: a noninvasive screening approach using captopril renography.

BACKGROUND Noninvasive cost-effective screening of hypertensive patients for renovascular hypertension is a desirable approach to a rare disorder. Currently many patients are screened with angiography, which is both invasive and expensive. METHODS A MEDLINE search from 1985 through July 1994 using the key words "renovascular hypertension," "noninvasive," "screening" generated 16 references. We reviewed these references, as well as several additional references, in an effort to find a reliable noninvasive screening test for renovascular hypertension. RESULTS AND CONCLUSIONS To date, the most reliable noninvasive screening test for renovascular hypertension is captopril renography. Results of captopril renography allow the physician to diagnose renovascular hypertension with an accuracy of greater than 90 percent. Cost-effectiveness requires appropriate selection of high-risk hypertensive patients for subsequent investigation with captopril renography. Hypertensive patients who have fibromuscular dysplasia, which is most commonly found in young white women, have the best treatment outcomes.