Renal artery stenosis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
The following are the list of medications indicated for patients with RAS with their corresponding level of evidence, based on ACC/AHA Guidelines for the Management of PAD<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654|year=2006|month=March |pmid=16549646|doi=10.1161/CIRCULATIONAHA.106.174526|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref> | |||
{|border="1" style="border-collapse:collapse; text-align:left; font-size:120%;" cellpadding="5" align="center" width="400px" | |||
| bgcolor="#ff9a69" align="center"|'''Medication Class'''||bgcolor="#ff9a69" align="center"|'''Level of Evidence''' | |||
|- | |||
| bgcolor="#f3f3f3"| ACE-Inhibitors | |||
| A | |||
|- | |||
|bgcolor="#f3f3f3"| Calcium Channel Blockers | |||
| A | |||
|- | |||
| bgcolor="#f3f3f3"| Beta-Blockers | |||
| A | |||
|- | |||
| bgcolor="#f3f3f3"| Thiazide Diuretics | |||
| A | |||
|- | |||
| bgcolor="#f3f3f3"| ARB | |||
| B | |||
|} | |||
Patients with RAS are recommended to start pharmacologic therapy using ACE-I or CCB, both of which have been proven effective not only for lowering blood pressure values, but also for nephroprotection.<ref name="pmid14582030">{{cite journal| author=Plouin PF| title=Stable patients with atherosclerotic renal artery stenosis should be treated first with medical management. | journal=Am J Kidney Dis | year= 2003 | volume= 42 | issue= 5 | pages= 851-7 | pmid=14582030 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14582030 }} </ref><ref name="pmid12557864">{{cite journal| author=Nordmann AJ, Woo K, Parkes R, Logan AG| title=Balloon angioplasty or medical therapy for hypertensive patients with atherosclerotic renal artery stenosis? A meta-analysis of randomized controlled trials. | journal=Am J Med | year= 2003 | volume= 114 | issue= 1 | pages= 44-50 | pmid=12557864 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12557864 }} </ref><ref name="pmid9655655">{{cite journal| author=Webster J, Marshall F, Abdalla M, Dominiczak A, Edwards R, Isles CG et al.| title=Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group. | journal=J Hum Hypertens | year= 1998 | volume= 12 | issue= 5 | pages= 329-35 | pmid=9655655 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9655655 }} </ref><ref name="pmid9495267">{{cite journal| author=Plouin PF, Chatellier G, Darné B, Raynaud A| title=Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group. | journal=Hypertension | year= 1998 | volume= 31 | issue= 3 | pages= 823-9 | pmid=9495267 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9495267 }} </ref><ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006|month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref> Other well-established therapies for lowering blood pressures in RAS are beta-blockers, chlorothiazides, and hydrazine.<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006|month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref> | Patients with RAS are recommended to start pharmacologic therapy using ACE-I or CCB, both of which have been proven effective not only for lowering blood pressure values, but also for nephroprotection.<ref name="pmid14582030">{{cite journal| author=Plouin PF| title=Stable patients with atherosclerotic renal artery stenosis should be treated first with medical management. | journal=Am J Kidney Dis | year= 2003 | volume= 42 | issue= 5 | pages= 851-7 | pmid=14582030 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14582030 }} </ref><ref name="pmid12557864">{{cite journal| author=Nordmann AJ, Woo K, Parkes R, Logan AG| title=Balloon angioplasty or medical therapy for hypertensive patients with atherosclerotic renal artery stenosis? A meta-analysis of randomized controlled trials. | journal=Am J Med | year= 2003 | volume= 114 | issue= 1 | pages= 44-50 | pmid=12557864 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12557864 }} </ref><ref name="pmid9655655">{{cite journal| author=Webster J, Marshall F, Abdalla M, Dominiczak A, Edwards R, Isles CG et al.| title=Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group. | journal=J Hum Hypertens | year= 1998 | volume= 12 | issue= 5 | pages= 329-35 | pmid=9655655 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9655655 }} </ref><ref name="pmid9495267">{{cite journal| author=Plouin PF, Chatellier G, Darné B, Raynaud A| title=Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group. | journal=Hypertension | year= 1998 | volume= 31 | issue= 3 | pages= 823-9 | pmid=9495267 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9495267 }} </ref><ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006|month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref> Other well-established therapies for lowering blood pressures in RAS are beta-blockers, chlorothiazides, and hydrazine.<ref name="pmid16549646">{{cite journal |author=Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation |journal=[[Circulation]] |volume=113 |issue=11 |pages=e463–654 |year=2006|month=March |pmid=16549646 |doi=10.1161/CIRCULATIONAHA.106.174526|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16549646 |accessdate=2012-10-09}}</ref> | ||
Revision as of 06:02, 8 November 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
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Medical Therapy
The following are the list of medications indicated for patients with RAS with their corresponding level of evidence, based on ACC/AHA Guidelines for the Management of PAD[1]
| Medication Class | Level of Evidence |
| ACE-Inhibitors | A |
| Calcium Channel Blockers | A |
| Beta-Blockers | A |
| Thiazide Diuretics | A |
| ARB | B |
Patients with RAS are recommended to start pharmacologic therapy using ACE-I or CCB, both of which have been proven effective not only for lowering blood pressure values, but also for nephroprotection.[2][3][4][5][1] Other well-established therapies for lowering blood pressures in RAS are beta-blockers, chlorothiazides, and hydrazine.[1]
Although the role of ARBs is known in lowering BP, there are currently no reliable trials that validate the use of ARBs in RAS. As such, further investigation is required.[1]
2005 ACCF/AHA Guidelines for the Management of Patients With Peripheral Artery Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (DO NOT EDIT)[1]
Medical Treatment (DO NOT EDIT)[1]
| Class I |
| "1. Angiotensin-converting enzyme inhibitors are effective medications for treatment of hypertension associated with unilateral RAS. (Level of Evidence: A)" |
| "2. Angiotensin receptor blockers are effective medications for treatment of hypertension associated with unilateral RAS. (Level of Evidence: B)" |
| "3. Calcium-channel blockers are effective medications for treatment of hypertension associated with unilateral RAS. (Level of Evidence: A)" |
| "4. Beta-blockers are effective medications for treatment of hypertension associated with RAS. (Level of Evidence: A)" |
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. doi:10.1161/CIRCULATIONAHA.106.174526. PMID 16549646. Retrieved 2012-10-09. Unknown parameter
|month=ignored (help) - ↑ Plouin PF (2003). "Stable patients with atherosclerotic renal artery stenosis should be treated first with medical management". Am J Kidney Dis. 42 (5): 851–7. PMID 14582030.
- ↑ Nordmann AJ, Woo K, Parkes R, Logan AG (2003). "Balloon angioplasty or medical therapy for hypertensive patients with atherosclerotic renal artery stenosis? A meta-analysis of randomized controlled trials". Am J Med. 114 (1): 44–50. PMID 12557864.
- ↑ Webster J, Marshall F, Abdalla M, Dominiczak A, Edwards R, Isles CG; et al. (1998). "Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group". J Hum Hypertens. 12 (5): 329–35. PMID 9655655.
- ↑ Plouin PF, Chatellier G, Darné B, Raynaud A (1998). "Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group". Hypertension. 31 (3): 823–9. PMID 9495267.