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Renal artery stenosis (RAS) is the most prevalent cause of secondary hypertension (HTN). Percutaneous trans-luminal renal angioplasty (PTRA) is used for both diagnosis and treatment of RAS. As many as one third of RAS cases fail to demonstrate post-PTRA HTN improvement. In this study, brain natriuretic peptide (BNP) was measured for consecutive patients with refractory HTN referred for renal artery angiography and 2 groups of participants (essential HTN and RAS) were compared. BNP was found significantly higher among RAS group than those with essential HTN (P <0.001) and had a good sensitivity (76%) to discriminate RAS from essential HTN. RAS cases also showed a statistically significant decline in BNP level (P <0.001) after PTRA. We concluded that BNP is increased in RAS before intervention, is declined after PTRA, and might be used both as a marker for discriminating RAS from essential refractory HTN and for post-PTRA follow-up.