A patient with hypertension is on three medications and experiences continued high blood pressure. This is most likely due to which condition affecting the renal arteries?

Fibromuscular dysplasia is a condition that typically affects younger patients (usually women) and is characterized by abnormal growth of cells in the arterial wall, leading to stenosis or narrowing of affected blood vessels, including the renal arteries. This narrowing can reduce blood flow to the kidneys, triggering a cascade of events resulting in secondary hypertension due to increased renin release and subsequent activation of the renin-angiotensin-aldosterone system (RAAS).

In patients who are already on multiple antihypertensive medications yet still present with uncontrolled hypertension, fibromuscular dysplasia should be considered as a possible underlying cause. It is less commonly recognized than atherosclerosis, especially in older populations, which is why it may not be the immediate thought when encountering resistant hypertension in a younger demographic.

Other conditions listed also affect blood pressure regulation and can involve the renal arteries, but they present differently or typically affect different populations. Atherosclerosis is more prevalent in older patients and usually leads to hypertension in that demographic, while chronic renal disease is often a consequence of longstanding hypertension rather than a primary cause of resistant hypertension in younger patients. Coarctation of the aorta can cause hypertension but typically presents with a specific set of symptoms and findings related to