Atherosclerotic renal artery stenosis, ACE inhibitors, and avoiding cardiovascular death.

Correspondence to: Dr John Main, Renal Unit, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK; [email protected] _________________________ A therosclerotic renal artery stenosis (ARAS) has become topical since the development of percutaneous angioplasty and stenting. Studies defining the place for intervention have been difficult to perform and inconclusive. However, it is becoming clear that intervention makes only a modest contribution to blood pressure control. Furthermore, although ARAS is often present in elderly patients with renal impairment, the contribution of intervention to preventing progression of renal failure has been disappointing. The increasingly widespread use of angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) has increased the clinical relevance of ARAS, and may be altering the indications for intervention. ARAS is more likely to end in cardiovascular death than renal failure, suggesting that it may be more rewarding to focus on the heart than the kidneys in this condition.