Renal artery stenosis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian, 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 unilateral renal artery stenosis (RAS) with their corresponding level of evidence, based on 2013 ACC/AHA Guidelines for the Management of PAD[1]
| Medication Class | Level of Evidence |
| ACE-Inhibitors | A |
| Calcium Channel Blockers | A |
| Beta-Blockers | 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 delaying renal disease.[2][3][4][5][6] Other well-established therapies for lowering blood pressures in RAS are beta-blockers, chlorothiazides, and hydrazine.[6] The use of medications to treat RAS should be based on recommendations for management of hypertension set by JNC in 2004[7] and/or ESH/ESC guidelines in 2013[8].
Although the role of ARBs is known in lowering BP, they can be used for lowering high blood pressure associated with unilateral RAS.[1]
2013 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 Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (13): 1425–43. doi:10.1161/CIR.0b013e31828b82aa. PMID 23457117.
- ↑ 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.
- ↑ 6.0 6.1 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) - ↑ Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL; et al. (2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". JAMA. 289 (19): 2560–72. doi:10.1001/jama.289.19.2560. PMID 12748199.
- ↑ Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M; et al. (2013). "2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension". J Hypertens. 31 (10): 1925–38. doi:10.1097/HJH.0b013e328364ca4c. PMID 24107724.