A patient with resistant hypertension and a left upper abdominal bruit is most likely suffering from which underlying condition?

The presence of resistant hypertension alongside a left upper abdominal bruit suggests that the patient is likely experiencing renal artery stenosis. This condition occurs when one of the renal arteries becomes narrowed, which can lead to decreased blood supply to the kidney. The kidney responds to this decreased perfusion by activating the renin-angiotensin-aldosterone system (RAAS), resulting in increased blood pressure.

The abdominal bruit is an important clinical sign that indicates turbulent blood flow in the renal artery, which is often due to the narrowing associated with stenosis. In patients with resistant hypertension—who do not respond to typical antihypertensive treatments—renal artery stenosis is a common underlying condition that should be evaluated, particularly if the bruit is detected on examination.

Other conditions, while they may also contribute to hypertension, are less directly associated with both resistant hypertension and the physical exam finding of an abdominal bruit. For example, pheochromocytoma involves episodic hypertension often with other signs such as palpitations and sweating but does not typically cause an abdominal bruit. Cushing syndrome can lead to hypertension as part of its broader symptom complex but lacks the specific bruit characteristic of renal artery stenosis. Coarctation of the aorta generally presents with discrepancies in blood pressure