• tiredness
• confusion
• vision changes
• nausea and vomiting
• angina-like chest pain (crushing chest pain)
• congestive heart failure

Elevated blood pressure measurements , repeated over time, confirm hypertension. Renovascular hypertension is often severely high and difficult to treat. Diastolic blood pressure (the "bottom" number, a reflection of the pressure in blood vessels when the heart is at rest) is often higher than 104 (normal is less than 80 to 90).

Renovascular hypertension is suspected when:

• The onset of hypertension occurs at an advanced age
• Stable, controlled hypertension suddenly becomes more difficult to treat
• Hypertension requires multiple medications for its satisfactory control

There may be signs of complications. Bruits ("whooshing" noises over an artery) may be heard with a stethoscope over the abdomen or flank areas.

Atherosclerosis or renal stenosis may show on:

• renal scan testing that includes administration of an angiotensin-converting enzyme (ACE) inhibitor such as captopril
• renal angiography (injection of dye into the renal artery so that a narrowing of the artery can be seen on an x-ray)
• intravenous pyelogram that shows slow uptake in one or both kidneys
• renal ultrasound with Doppler evaluation of the renal arteries