Atherosclerosis is a diffuse disease that can affect renal arteries. An important point for the management of hypertensive patients is the prevalence of anatomical renal stenosis when lower-limb peripheral vascular disease coexists with hypertension. From Sept 1, 1987, to Aug 31, 1990, 252 consecutive hypertensive adults with peripheral vascular disease were referred to our clinic. For each patient a standardised collection of information was checked and registered with a computerised system. The evaluation included the search for a curable cause of hypertension, the investigation of cardiovascular risk factors, and a complete clinical review. Peripheral vascular disease was confirmed at least by clinical observation, including and ankle/brachial systolic blood pressure ratio of less than 0.90 at rest. In 117 patients (73 males, 44 females, mean age 66), renal arteriography was performed because clinical history, initial diagnostic work-up, or duplex Doppler examination suggested renal artery stenosis. Finally, 89 anatomical renal artery stenoses were detected in 64 patients (54.7%). Stenosis was judged mild (25 to 50%) in 12 patients and severe (> 50%) in 52 patients including 5 occlusions of the renal arteries. Artery stenosis was found bilateral in 23 patients. Even if none patient without renal arteriography would have an anatomical renal artery stenosis, the prevalence of anatomical renal stenosis in this study would reach 25.4% (64/252). These results confirm that lower-limb peripheral vascular disease is an excellent marker for the presence of anatomical artery renal stenosis in hypertensive patients.