A 37-year old woman was suspected of having
renovascular hypertension because of recent onset severe
hypertension (blood pressure 220/135 mmHg; compared to 132/65 mmHg two years earlier) and an abdominal bruit. A
captopril renal scan indicated the presence of right
renal artery stenosis. Additionally, a
captopril plasma
renin activity (PRA) provocation test showed a positive result for
renovascular hypertension (baseline PRA = 291 microU/mL; 1 hour post-
captopril PRA = 1444 microU/mL). Selective renal angiography demonstrated a severe critical stenotic lesion at the distal portion of the right renal artery. Blood pressure (BP) decreased to 136/80 mmHg one day after successful percutaneous transluminal renal angioplasty and stenting. Repeat renal angiography six months after the procedure revealed no evidence of in-
stent restenosis. Blood pressure (BP = 137/76 mmHg) and plasma
renin profile (baseline PRA = 23.8 microU/mL; 1 hour post-
captopril PRA=22.3 microu/mL) also were normal six months following initial revascularization. Moreover, blood pressure (137/84 mmHg) and
renin profile remained normal 2.5 years after the procedure (baseline PRA = 24.3 microU/mL; 1 hour post-
captopril = 25.6 microU/mL). The results of this study have thus demonstrated a case of
renin-dependent
renovascular hypertension in which both the blood pressure and plasma
renin activity profile normalized following successful percutaneous transluminal angioplasty and stenting.