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Health condition

Fibromuscular dysplasia, the arterial disease that hides behind resistant blood pressure and young strokes.

Not atherosclerosis, not vasculitis. FMD is a distinctive arteriopathy of medium-sized arteries, usually first seen as resistant hypertension, pulsatile tinnitus or an unexpected dissection.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against European FMD Consensus 2019, US Society for Vascular Medicine and specialist sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK specialist practice including full head-to-pelvis vascular screening and antiplatelet therapy for all patients.

Key facts

Fibromuscular dysplasia at a glance.

The essentials, in plain English - who develops FMD, where it strikes, and how it is treated in the UK today.

  • What it is

    A non-atherosclerotic, non-inflammatory arteriopathy of medium-sized arteries causing stenosis, aneurysm, dissection and tortuosity.

  • Who gets it

    Around 90% of diagnosed patients are women, most identified in their 30s to 50s. Angiographic prevalence in the general population is roughly 1 to 4%.

  • Where it strikes

    Renal arteries most often (causing hypertension), then extracranial carotid and vertebral arteries. Coronary FMD underlies many cases of spontaneous coronary artery dissection.

  • Classic appearance

    The multifocal “string of beads” pattern of alternating stenosis and dilation accounts for around 80% of cases. The focal type is rarer and often more aggressive.

  • How it is confirmed

    CT or MR angiography of the whole vascular tree, head to pelvis, at diagnosis. Catheter angiography is definitive and often therapeutic.

  • Cornerstones of care

    Aspirin for all, tight blood-pressure control (usually with an ACE inhibitor or ARB), lifestyle change and angioplasty for symptomatic renal disease.

Why this guide matters

A specialist condition that shouldn’t be missed.

FMD is rare enough to be under-recognised, but common enough that most vascular services see it every year. The three points below shape everything else on this page.

  • It is not atherosclerosis

    FMD is a distinct disease of the artery wall, not driven by cholesterol - so risk-factor logic and cholesterol drugs do not apply in the usual way.

  • Look everywhere, not just one artery

    Because FMD is often multi-territory, specialists image from head to pelvis at diagnosis to find silent disease and aneurysms.

  • Small drugs, big impact

    Aspirin and an ACE inhibitor or ARB, plus targeted angioplasty when needed, control most patients well for the long term.

How the diagnosis is made

From first suspicion to a whole-body map.

The steps a UK vascular specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and risk profile

    Young woman with resistant hypertension, unexplained stroke or TIA, pulsatile tinnitus, migraine, or a family history of FMD or dissection.

  2. 02

    Assessing

    Focused examination

    Blood pressure in both arms, listening for carotid, abdominal and flank bruits, and a full neurovascular examination.

  3. 03

    Assessing

    Screening ultrasound

    Doppler ultrasound of the carotid and renal arteries is often the first non-invasive test.

  4. 04

    Confirming

    CT or MR angiography

    Cross-sectional angiography is the gold standard, showing the classic beading, focal narrowing or aneurysm formation.

  5. 05

    Confirming

    Head-to-pelvis vascular screen

    Because FMD is often multi-territory, specialists image the whole vascular tree at diagnosis, per US FMD Registry practice.

  6. 06

    Planning

    Catheter angiography if needed

    Reserved for definitive diagnosis in equivocal cases and for planning or delivering angioplasty in the same setting.

  7. 07

    Planning

    Selective genetic counselling

    Considered where there is a strong family history or a suggestion of an inherited connective-tissue disorder, alongside first-degree relative screening.

Typical timeline: from first suspicion to a settled plan in weeks, through a specialist commissioned FMD service.

Symptoms

What FMD can look like.

The pattern is often surprising - hypertension in a young woman, a whooshing ear, a stroke without risk factors, or an unexpected heart attack.

  • Resistant hypertension

    Young or middle-aged women whose blood pressure remains high despite two or three medications, often the first clue to renal FMD.

  • Headache and migraine

    Chronic headache or migraine is common, particularly with carotid or vertebral involvement.

  • Pulsatile tinnitus

    A rhythmic whooshing in the ear that beats with the pulse, classically linked to carotid FMD.

  • TIA, stroke or dissection

    Cerebrovascular events, arterial dissection and, rarely, subarachnoid haemorrhage from an associated intracranial aneurysm.

  • Horner syndrome

    Drooping eyelid, small pupil and reduced sweating on one side, sometimes signalling internal carotid dissection.

  • Chest pain in a young woman

    Coronary FMD is closely tied to spontaneous coronary artery dissection, a leading cause of heart attack in young women.

  • Abdominal pain or weight loss

    Mesenteric FMD can cause post-meal pain and weight loss, though this is less common than renal or carotid disease.

  • Red flag - acute neurology

    Sudden severe headache, focal weakness, speech or vision change means an emergency call to 999.

Treatment

How FMD is treated in the UK.

Aspirin for all, tight blood-pressure control, targeted angioplasty for symptomatic renal disease, and specialist management of aneurysms and dissection.

  • Antiplatelet therapy

    Low-dose aspirin for all patients unless contraindicated, to reduce cardiovascular and cerebrovascular events.

  • Blood-pressure control

    An ACE inhibitor or angiotensin receptor blocker is first-line for renal FMD, alongside monitoring of renal function and potassium.

  • Lifestyle measures

    Smoking cessation, home blood-pressure monitoring and avoidance of heavy weight lifting or forceful Valsalva to protect aneurysms.

  • Percutaneous angioplasty (PTA)

    First-line for symptomatic renal FMD - often cures or greatly reduces resistant hypertension and lowers medication burden.

  • Selective stenting

    Reserved for suboptimal angioplasty results, dissection during PTA or focal disease, delivered by specialist interventional radiology.

  • Aneurysm management

    Endovascular coiling, stent-graft repair or surgical clipping for symptomatic or high-risk aneurysms, led by neuroradiology or vascular surgery.

  • Dissection care

    Most arterial dissections are managed conservatively with antiplatelet therapy and close imaging follow-up.

  • Specialist MDT surveillance

    Annual clinical review with cross-sectional imaging every three to five years, coordinated through a specialist commissioned FMD service.

For coronary FMD and myocardial infarction in younger women, see our dedicated guide to spontaneous coronary artery dissection.

What this guide is based on

The sources behind every claim on this page.

International consensus statements and specialist society standards, current at the time of last review.

Key references

Consensus statements and society standards.

A quiet reminder

This guide is for information, not medical advice.

Your GP, cardiologist or vascular specialist knows your case and can tell you which parts apply to you. If in doubt, get seen.

  • Gornik HL et al. First International Consensus on the Diagnosis and Management of Fibromuscular Dysplasia (2019).

  • Persu A et al. European Consensus on the diagnosis and management of fibromuscular dysplasia.

  • US Society for Vascular Medicine and US FMD Registry recommendations.

  • European Society of Cardiology guidelines on spontaneous coronary artery dissection and hypertension.

Red flags

When FMD needs urgent attention.

Most patients are stable on medication and monitoring. These are the situations that aren’t - and where emergency or specialist input is needed.

  • Sudden severe headache

    A thunderclap headache may signal subarachnoid haemorrhage from a ruptured intracranial aneurysm. Call 999.

  • Stroke or TIA symptoms

    Sudden weakness, numbness, speech difficulty or vision loss needs immediate emergency assessment.

  • Neck pain with Horner syndrome

    Neck or facial pain with a droopy eyelid and small pupil can indicate carotid dissection.

  • Chest pain in a young woman

    May reflect spontaneous coronary artery dissection linked to coronary FMD and needs urgent cardiology assessment.

  • Uncontrolled hypertension

    A blood pressure that refuses to settle on three or more agents, especially in a young woman, warrants investigation for renal FMD.

  • Acute severe abdominal pain

    Consider mesenteric ischaemia or a ruptured visceral aneurysm - emergency imaging and vascular review are needed.

  • New pulsatile abdominal mass

    Any pulsatile mass or unexplained flank pain deserves urgent vascular imaging.

  • Pregnancy planning with known FMD

    Individualised specialist review is essential before and during pregnancy, particularly with known aneurysms.

  • First-degree relative with FMD

    Around 10% of cases are familial - relatives should be offered clinical assessment and screening.

Living with it

A long-term diagnosis, with a clear plan.

Four things that make the biggest difference day to day - staying on treatment, stopping smoking, protecting fragile arteries and knowing your warning signs.

A quiet reminder

Consistency beats intensity, every time.

Steady blood-pressure control and yearly review do more than occasional heroics.

  1. 01 Meds

    Stay on your aspirin and BP treatment

    Consistency with antiplatelet and antihypertensive therapy is the single biggest lever for long-term risk.

  2. 02 Lifestyle

    Stop smoking, protect your arteries

    Smoking accelerates FMD complications - stopping is one of the most important things you can do.

  3. 03 Care

    Avoid heavy lifting and Valsalva

    Ask your specialist about safe exercise - most patients can stay active, but forceful straining can stress aneurysms.

  4. 04 Escalate

    Know your warning signs

    Sudden neurological, chest or abdominal symptoms need emergency care, not a wait-and-see approach.

Frequently asked

Everything we get asked about FMD.

Quick answers on diagnosis, angioplasty, family screening and the link with SCAD.

  • What is fibromuscular dysplasia?

    Fibromuscular dysplasia (FMD) is a rare, non-atherosclerotic and non-inflammatory disorder of medium-sized arteries. It causes stenosis, dilation, aneurysm, dissection and tortuosity, most often affecting the renal and carotid arteries.

  • Who typically develops FMD?

    Around 90% of diagnosed patients are women, most identified between the ages of 30 and 50. Risk factors include a family history of FMD or arterial dissection, smoking and, probably, hormonal and mechanical influences.

  • How is FMD diagnosed?

    Doppler ultrasound of the carotid and renal arteries is a common first step, but CT or MR angiography is the gold standard, showing the classic “string of beads” or focal narrowing. Catheter angiography is used for definitive diagnosis and treatment when needed.

  • Does FMD always need surgery?

    No. Many patients are managed with medication alone - aspirin plus tight blood-pressure control. Percutaneous angioplasty is offered for symptomatic renal disease, and surgery is reserved for complex cases, aneurysms or failed angioplasty.

  • Is FMD the same as spontaneous coronary artery dissection?

    They are closely linked. Coronary FMD underlies many cases of spontaneous coronary artery dissection (SCAD), a leading cause of heart attack in young women. Anyone with SCAD should be screened for FMD elsewhere.

  • Should my family be screened?

    About 10% of cases are familial, so first-degree relatives are offered clinical assessment. Selective genetic testing is considered in strong family clusters or when a connective-tissue disorder is suspected.

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