Role of Renin-Angiotensin System Blockade in Atherosclerotic Renal Artery Stenosis and Renovascular Hypertension

Hackam, Daniel G.; Spence, J. David; Garg, Amit X.; Textor, Stephen C.

doi:10.1161/hypertensionaha.107.097345

Cited by 73 publications

(44 citation statements)

References 61 publications

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“…12 Atherosclerotic RAS is linked to heart failure, and the presence of RAS worsens overall prognosis in patients with heart failure. 13 In fact, RAS defined as >50% luminal narrowing detected by MR angiography was found in 39% of elderly patients with heart failure, 14 and in 59% of patients with systolic heart failure. 15 Prevalence of RAS in highrisk hypertensive patients has been recently reviewed by de Mast et al 16 Prevalence of RAS ranged from 10 to 20% in six angiographic studies of patients with suggestive of renovascular hypertension; a pooled prev alence of RAS was 20% from three studies in patients with diabetes mellitus and coexistent hypertension: a significant RAS was demonstrated in 17.8% of 836 hypertensive patients with coronary heart disease.…”

Section: Discussionmentioning

confidence: 99%

Association of Renal Artery Stenosis With Aortic Jet Velocity in Hypertensive Patients With Aortic Valve Sclerosis

Iida¹,

Maeda²,

Yamamoto³

et al. 2010

American Journal of Hypertension

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Section: Discussionmentioning

confidence: 99%

Association of Renal Artery Stenosis With Aortic Jet Velocity in Hypertensive Patients With Aortic Valve Sclerosis

Iida¹,

Maeda²,

Yamamoto³

et al. 2010

American Journal of Hypertension

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“…This activates complex pathways of oxidative stress and inflammatory injury. 30 Under these conditions, management of essential hypertension with medical therapy might be more important than stenting, partially explaining the failure of angioplasty. Another hypothesis suggests that activation of the reninangiotensin-aldosterone system leads to remodeling and permanent changes in the renal vasculature that are not reversed by PTRAS.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Revascularization Versus Medical Therapy for Atherosclerotic Renal Artery Stenosis

Riaz

Husnain

Riaz

et al. 2014

The American Journal of Cardiology

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“…RAAS blockade has been associated with more effective BP control in renovascular hypertension than had been possible in the past, particularly with unilateral disease. Agents, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), can be administered safely and are well tolerated in nearly 90% of RAS patients (1,2). According to registry and observational data, patients with RAS treated with these agents have more favorable clinical outcomes than patients treated without them.…”

Section: Case Discussionmentioning

confidence: 99%

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2014

Clinical Journal of the American Society of Nephrology

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This case represents an individual with accelerating hypertension and declining kidney function associated with atherosclerotic renal artery stenosis. Key features include loss of GFR (reaching stage V CKD) during intensified antihypertensive drug therapy including agents that block the renin-angiotensin system and failure to appreciate the extent to which moderate renal artery stenosis was affecting his better kidney. Interpretation of duplex ultrasound studies was complicated by a discrepancy between near-normal peak systolic velocities and markedly abnormal segmental arterial waveforms. It was essential to recognize that both kidneys were abnormal and focus on recovery of perfusion to the better of these kidneys. Successful revascularization of one kidney allowed major improvement in GFR and BP control.Clin J Am Soc Nephrol 9: 1117-1123, 2014. doi: 10.2215/CJN.09030813 Case SummaryA 74-year-old retired businessman was referred for CKD stages 4 and 5 associated with an atrophic kidney, accelerated hypertension, and consideration for RRT, including renal transplantation. His history was notable for a remote history of smoking, hypertension for more than 25 years, and emergent surgical repair of a leaking abdominal aortic aneurysm 12 years previously. During the previous 2 years, he was hospitalized two times for malignant phase hypertension. In one instance, he had transient facial and upper extremity weakness associated with arterial pressures of 240/125 mmHg. Symptoms improved as BP fell with therapy. Eight months later, he was readmitted with symptoms of encephalopathy and dyspnea, again with BP above 230/120 mmHg. Initial evaluation showed a small kidney (8.6 cm by ultrasound) on the right and a left kidney of normal size (12.5 cm). Serum creatinine had risen over this period from 1.3 to 2.5 mg/dl. It rose to 3.8 mg/dl over the 1 month before referral.Renal arteriography 6 months ago showed a highgrade right renal artery stenosis (RAS) and moderate left RAS. An attempt at stenting the right renal artery was unsuccessful, attributed to severe atherosclerosis and vascular tortuosity.Medications at this time included aliskiren, 150 mg every day; carvedilol, 25 mg two times per day; clonidine, 0.3 mg three times per day; minoxidil, 2.5 mg two times per day; valsartan, 160 mg two times per day; furosemide, 80 mg in a.m. and 40 mg in p.m.; aspirin, and darbopoeitin-a, 60 mcg subcutaneously one time per week. He was also taking omeprazole, aspirin, clopidogrel, and vitamin D2.Examination was remarkable for BP5146-182/70 mmHg and body mass index of 28.1. He was fully alert without neurologic deficits. Carotid, epigastric, and lower abdominal bruits were audible. Cardiac rhythm was regular with a fourth heart sound. A well healed abdominal scar was evident. There was a trace of edema.Laboratory values included hemoglobin, 11.5 g/dl; hematocrit, 34%; white blood cell count, 4300; platelets, 92,000/ml; BUN, 57 mg/dl; sodium, 138 meq/L; potassium, 5.1 meq/L; bicarbonate, 29 meq/L; and chloride, 97 meq/L. Serum ...

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Role of Renin-Angiotensin System Blockade in Atherosclerotic Renal Artery Stenosis and Renovascular Hypertension

Cited by 73 publications

References 61 publications

Association of Renal Artery Stenosis With Aortic Jet Velocity in Hypertensive Patients With Aortic Valve Sclerosis

Association of Renal Artery Stenosis With Aortic Jet Velocity in Hypertensive Patients With Aortic Valve Sclerosis

Meta-Analysis of Revascularization Versus Medical Therapy for Atherosclerotic Renal Artery Stenosis

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