What is the imaging work up for hypertension?
Imaging needs are defined by the possible etiology of the hypertension. For renovascular hypertension, per the American College of Radiology (ACR) Appropriateness Criteria ( http://www.acr.org/quality-safety/appropriateness-criteria ), MRI and CTA with and without contrast rank the highest tier.
• MRA without contrast
• US Doppler and angiotensin converting enzyme I (ACE-I) renography are second tier.
• All other studies are not recommended.
• For patients with reduced kidney function, only MRA without contrast and ultrasound are recommended. If coarctation is suspected, then a chest x-ray along with either chest CT or chest MRI would be indicated. For suspected adrenal lesions, abdominal CT or abdominal MRI are the best modalities. For pheochromocytoma, nuclear studies with 131 I-metaiodobenzylguanidine (MIBG) is diagnostic.
• Echocardiography can be used prognostically looking for morphologic changes to the atria and ventricles as a result of hypertension.
