Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension.

Current management of atherosclerotic renal artery stenosis (ARAS) remains controversial. A major issue is the condition’s functional significance; specifically, what is the contribution of ARAS to a specified patient’s heart failure, hypertension, or progressive renal disease? Clinicians will often consider whether revascularization of ARAS is likely to alter a patient’s symptoms or prognosis. Yet, even when ARAS is incidentally detected, patients are at high risk for future cardiovascular events and death. This suggests that regardless of the clinical scenario, intensive medical therapy should be provided to all patients in whom ARAS is discovered. Here we review evidence that angiotensin inhibitors (angiotensin-converting enzyme [ACE] inhibitors and angiotensin receptor blockers [ARBs]) may improve the prognosis of ARAS. To place this evidence into context, it is important to first review the prognosis of this condition.