Hypertension and Renal Artery Stenosis

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Submitted by Dr T on August 7, 2014 – 9:47am

I was diagnosed with high blood pressure  about a year and half ago. Recently  I had some swelling in hands and feet that wouldn’t go down some called doctor. She had me come in and check BP which was raised even on my medicine which was Exforge. She switched me to Bisoprolol/HCTZ 5mg/6.25mg tabs and sent me to do a Doppler ultrasound of my kidneys. Results were right main renal artery had 195 cm/sec peak systolic velocity which correlates with angiographic findings of 60-99% diameter reduction. I was then sent to a cardiac vascular surgeon on the July 28th. He said I needed angioplasty with stent and said he wanted me to do a CTA to check for masses. Said they would call to schedule the procedure and that a different cardiologist would do it. They scheduled the CTA for August 1. On August 1st the other practice called and scheduled angioplasty for the 6th. On Monday the 4th I  went for pre op testing and picked up CTA report so I could see it and noticed it said no renal artery stenosis. I immediately called the doctor and was told he was out of town but nurse said to cancel procedure. They won’t say whether I have it or not since he is out of town. Which test is best and how do u know which one is right? BP was 152/90 with new medicine.  Female 32 yrs old overweight. My grandpa had heart disease areound 40 and had angioplasty with stent for it. I also had EKG about a year ago which showed mild elevation of pulmonary  pressure but otherwise normal. Grandfather also had kidney cancer and kidney then removed.  Any info on what u would recommend would be greatly appreciated. Thanks for your time.
Renal artery stenosis
Hi Brandy,
A CTA is more accurate than an ultrasound study of your renal arteries. You either have renal artery stenosis or not, but even that doesn’t automatically means you need a stent. While your current medical therapy for hypertension may need further adjustment, including diet, exercise and weight reduction efforts (which will also help with elevated pulmonary artery pressures and other cardiac risks), a stent or bypass surgery should be considered only if medical therapy and other treatments have failed.
Hope this helps,

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