For many years and even decades a diagnostic work-up to look for a secondary form of hypertension, particularly of renovascular origin has been a central tenet in medicine. Atherosclerotic renal artery stenosis is considered as the most common cause of renovascular hypertension. However, advances in understanding the complex patho-physiology of this condition and the recently documented futility of renal revascularization, bring into question whether atherosclerotic renal artery stenosis truly causes "renovascular hypertension". From a clinical point of view, a clear distinction should be made between hypertension associated with atherosclerotic renal artery stenosis and hypertension caused by renal artery stenosis induced activation of the renin-angiotensin-aldosterone system. Most patients with atherosclerotic renal artery stenosis do not have a form of hypertension that is remediable or improved by angioplasty; to expose them to the cost, inconvenience and risk of a diagnostic work-up add up to little more than a wild goose chase.
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