This article examines the status regarding prevalence, mechanisms, clinical manifestations and management of renovascular hypertension at this point in time. It should be viewed as a work in progress. As with most complex conditions, clinicians must integrate the results of published literature studies while considering each patient's specific features and comorbid disease risks. Beyond identifying renovascular disease as a cause of secondary hypertension, one must manage renal artery stenosis (RAS) itself as an atherosclerotic vascular complication. This disease warrants follow-up regarding progression and potential for ischemic tissue injury. These elements often determine the role and timing for revascularization. In this respect, atherosclerotic renal artery stenosis is analogous to progressive carotid or aortic aneurysmal disease.