Isabel Casimiro, MD, PhD, is an Endocrinologist at the University of Chicago and board-certified in internal medicine.

Hypertension, commonly known as high blood pressure, is a major risk factor for many different diseases, including heart disease, stroke, and dementia. Hypertension is also associated with chronic kidney disease (CKD) both as a cause and effect.

On the one hand, uncontrolled hypertension can cause the narrowing of blood vessels servicing the kidneys, decreasing blood flow and increasing kidney damage. On the other, kidneys damaged by CKD are less able to clear fluids from the body, causing a buildup of fluid that increases blood pressure.

Renal hypertension is the term used to describe high blood pressure caused by the narrowing of arteries that transport blood to the kidneys. It is a condition that indicates a significant progression of CKD and the need for immediate treatment to preserve the functions of the kidneys,

This article takes a look at the symptoms and causes of renal hypertension as well as the tests used to diagnose this complication of advanced renal (kidney) disease. It also explores the treatments that can slow the progression of CKD, including medications and specialist procedures.

Chronic kidney disease (CKD) is a persistent kidney disease that reduces the rate at which kidneys filter waste and fluids (as measured by the glomerular filtration rate, or GFR) accompanied by an increase in the amount of protein passed in urine (referred to as albuminuria ).

According to the Centers for Disease Control and Prevention (CDC), CKD affects 1 in 7 adults in the United States. Increases in the rate of CKD in recent decades have been attributed to an aging population along with increased rates of obesity, diabetes, and hypertension.

CKD and high blood pressure make for a deadly combination. Research suggests that 85% to 95% of people with mild to moderate CKD have clinical hypertension. Hypertension not only speeds the progression of CKD but is considered the second leading cause of end-stage renal disease (in which dialysis or a kidney transplant is needed for a person to survive).

Renal hypertension, also known as renovascular hypertension, is one of the more common forms of secondary hypertension. Unlike primary hypertension which occurs in the absence of other medical conditions, secondary hypertension is high blood pressure caused by another condition.

Renal hypertension develops when the narrowing of the arteries servicing the kidneys (referred to as renal artery stenosis) alters one of the major functions of the kidneys, namely the regulation of blood pressure.

When most people think about the kidneys, they generally regard them as the filtration system of the body. But, the kidneys are also responsible for maintaining fluid levels and, by doing so, help regulate blood pressure.

When renal artery stenosis occurs, the kidneys will respond to the reduced blood flow as if the body were experiencing dehydration, releasing a hormone called renin that triggers an increase in sodium levels. This causes water in the body to be retained which, in turn, increases blood pressure.

Renal artery stenosis is most commonly caused by atherosclerosis , the hardening and narrowing of arteries due to the buildup of plaque. Less commonly, it is caused by a disorder called fibromuscular dysplasia in which blood vessels throughout the body become fibrous and twisted.

According to a 2019 review from Mayo Clinic, renovascular hypertension accounts for between 1% and 5% of all cases of hypertension in the general U.S. population. The condition is most commonly seen in people with significant renal artery stenosis (greater than 60% obstruction).

Renal hypertension tends to affect adults over 65, although it can occur in people of any age. Around 90% of cases are caused by atherosclerosis, while 9% are linked to fibromuscular dysplasia. The risk factors vary by the underlying cause.

With atherosclerosis, the risk factors are similar to those for all heart diseases:

With fibromuscular dysplasia, females tend to be affected far more than males. Unlike atherosclerosis, most cases are diagnosed after 50. Smoking appears to increase the severity of the disease. Genetics is also thought to play a part.

Renal hypertension will often go unnoticed until signs of the disease are recognized on routine medical tests. In some cases, the condition may only be suspected when a person with high blood pressure doesn't respond to antihypertensive drugs.

As renal hypertension progresses and blood flow to the kidneys is significantly reduced, other, more overt symptoms may develop, including:

Even so, most cases of renal hypertension will be asymptomatic (without symptoms) until the condition is well advanced.

According to the CDC, around 90% of the 37 million people living with chronic kidney disease in the United States are wholly unaware of their condition.

If left untreated, renal hypertension can affect multiple organs. Persistently high blood pressure can place undue stress on blood vessels, causing them to rupture or bulge. It can also cause changes in organs that can lead them to fail or underperform.

Possible complications of renal hypertension include:

Renal hypertension can be diagnosed with a combination of a physical exam, lab tests, and a review of your medical history. Based on the findings, other tests may be ordered to pinpoint the underlying cause.

People with mild to moderate CKD are often asymptomatic. However, if the disease is advanced, a person may show signs of cachexia (wasting), periorbital edema (swelling around the eye), and peripheral edema (swelling of the legs, ankles, and feet). They may also report tiredness, shortness of breath with normal activity, decreased urine output.

The exam will also involve a stethoscope to listen for abdominal sounds, called bruits , that are caused by obstructed or turbulent blood flow. In people with renal artery stenosis, a whooshing sound will often be heard when a stethoscope is placed over the kidneys.

Blood and urine tests can provide evidence of renal hypertension. These typically include:

Imaging tests are used to diagnose and characterize renal artery stenosis in people with CKD. The types of tools used may include:

The treatment of renal hypertension can vary based on the severity of renal artery stenosis and other factors. This may involve lifestyle changes, medications to reduce blood pressure, and specialist procedures that improve blood flow to the kidneys.

If left untreated, renal hypertension can accelerate the progression of CKD and lead to end-stage renal disease.

If renal hypertension is diagnosed, lifestyle changes alone will not be enough to slow the progression of the disease. They can, however, modify or eliminate some of the risk factors that contribute to high blood pressure and CKD.

Among some of the lifestyle changes that can significantly improve outcomes in people with renal hypertension are:

The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend antihypertensive medications as the first-line therapy for renal hypertension. These drugs bring down blood pressure in different ways and help prevent further plaque buildup in arteries.

The ACC/AHA classifies the following two drugs as preferred, first-line agents:

Other drug options that can help lower blood pressure in people with renal hypertension include calcium channel blockers, thiazides diuretics ("water pills"), beta-blockers, and Dralzine (hydralazine).

There are no drugs that can reverse renal artery stenosis. If the obstruction of blood flow to the kidneys is significant, certain procedures may be recommended.

These procedures are generally considered when a person fails to respond to medications alone, cannot tolerate medications, or has unexplained pulmonary edema, congestive heart failure, or unstable angina.

The specialist procedures commonly used to treat renal hypertension include:

If you have been diagnosed with renal hypertension, there are things you can do to better cope with treatment. This includes seeing your kidney specialist regularly to monitor your kidney function and ensuring that all other chronic medical conditions you have are properly managed.

Here are some other ways to improve your well-being and quality of life if you have renal hypertension:

Renal hypertension is high blood pressure caused by damage to the kidneys. It is a condition that can occur in people with chronic kidney disease when the arteries servicing the kidneys become narrow and hardened (referred to as renal artery stenosis). Atherosclerosis is the most common cause of this.

Renal hypertension tends to affect people over 65, particularly those who smoke or are overweight. There may be few if any symptoms in the early stages. But, as the blood flow to the kidneys is progressively reduced, a cascade of symptoms—from nausea and low urine output to confusion and irregular heartbeat—can develop.

Renal hypertension can be diagnosed with a physical exam, blood and urine tests, imaging studies, and a review of your medical history. The first-line treatment is antihypertensive drugs like ACE inhibitors and angiotensin receptor blockers (ARBs).

For those whose condition is progressing despite medications, specialist procedures like balloon angioplasty or renal artery bypass surgery may be recommended.

It can be distressing to learn that you have chronic kidney disease or to hear that your condition is progressing despite treatment. The most important thing to remember is that CKD has no set course and that the disease can vary from one person to the next. Some people can live for many years with CKD and never progress to kidney failure.

By taking control of your condition—by making necessary lifestyle changes and taking your medications as prescribed—you can begin to normalize CKD in your life and reduce the daily stresses that can undermine both your health and quality of life.

This includes educating your family and friends so that they understand what CKD is, why certain lifestyle changes are needed, and what they can do to best support you.

A bruit is an audible noise caused by the turbulent flow of blood in an artery. In people with renal artery stenosis, the bruit will often be a whooshing sound that can be heard when a stethoscope is placed over the kidneys.

The stages of chronic kidney disease (CKD) describe the progression of the disease based on a test called the glomerular filtration rate (GFR):

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