Cardiovascular Drugs and Therapy

, Volume 4, Issue 1, pp 229–235 | Cite as

ACE inhibitors in renovascular hypertension

  • Stephen C. Textor
Focused Section: Angiotensin Converting Enzyme Inhibition: Renal Aspects


ACE inhibition has provided many insights into the etiology and treatment of renovascular hypertension. Not only have studies using these agents profoundly expanded our understanding of the mechanisms governing preservation of renal perfusion pressures and function beyond arterial lesions, they have provided tools for more precise diagnosis and therapy in clinical practice. ACE inhibitors must be considered the agents of choice for the treatment of renovascular hypertension and provide an effective and safe medical alternative for many patients developing atherosclerotic renovascular lesions with an otherwise unacceptable risk for revascularization procedures. With the advent of widespread clinical use of these agents, however, come many new questions regarding the long-term fate of the kidney beyond vascular lesions and the need for preservation of renal function.

Key Words

renal artery stenosis hypertension renin angiotensin kidney glomerular filtration renal blood flow 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Goldblatt H, Lynch J, Hanzal RE, Summerville WW. Studies on experimental hypertension I: The production of persistent elevation of systolic blood pressure by means of renal ischemia.J Exp Med 1934;59:347–379.Google Scholar
  2. 2.
    Genest J, Cartier P, Roy P, et al. Renovascular hypertension. In: Genest J, Kuchel O, Hamet P, eds.Hypertension: Physiopathology and Treatment. New York: McGraw-Hill, 1983.Google Scholar
  3. 3.
    Freeman RH, Davis JO, Watkins BE, et al. Effects of continuous converting enzyme blockade on renovascular hypertension in the rat.Am J Physiol 1979;236:F21–F24.PubMedGoogle Scholar
  4. 4.
    Freeman RH, Davis JO, Seymour AA. Volume and vasoconstriction in experimental renovascular hypertension.Fed Proc 1982;41:2409–2419.PubMedGoogle Scholar
  5. 5.
    Murphy WR, Coleman TG, Smith TL, Stanek KA. Effects of graded renal artery constriction on blood pressure, renal artery pressure and plasma renin activity in Goldblatt hypertension.Hypertension 1984;6:68–74.PubMedGoogle Scholar
  6. 6.
    Textor SC, Smith-Powell L. Post-stenotic arterial pressure, renal haemodynamics and sodium excretion during graded pressure reduction in conscious rats with one- and two-kidney coarctation hypertension.J Hypertens 1988;6:311–319.PubMedGoogle Scholar
  7. 7.
    Brunner HR, Kirshmann JD, Sealey JE, Laragh JH. Hypertension of renal origin: Evidence for two different mechanisms.Science 1971;174:1344–1346.PubMedGoogle Scholar
  8. 8.
    Gavras H, Brunner HR, Vaughan ED, Laragh JH. Angiotensin-sodium interaction in blood pressure maintenance of renal hypertensive and normotensive rats.Science 1973;180:1369–1370.PubMedGoogle Scholar
  9. 9.
    Blantz RC, Konnen KS, Tucker BJ. Angiotensin II effects upon the glomerular microcirculation and ultrafiltration coefficient of the rat.J Clin Invest 1976;57:419–434.PubMedGoogle Scholar
  10. 10.
    Lohmeier TE, Cowley AW. Hypertensive and renal effects of chronic low level intrarenal angiotensin infusion in the dog.Circ Res 1979;44:154–160.PubMedGoogle Scholar
  11. 11.
    Textor SC, Tarazi RC, Novick AC, et al. Regulation of renal hemodynamics and glomerular filtration in patients with renovascular hypertension during converting enzyme inhibition with captopril.Am J Med 1984;76:29–37.PubMedGoogle Scholar
  12. 12.
    Textor SC, Novick A, Mujais SK, et al. Responses of the stenosed and contralateral kidneys to (Sar-1, Thr-8) AII in human renovascular hypertension.Hypertension 1983;5: 796–804.PubMedGoogle Scholar
  13. 13.
    DeForrest JM, Davis JO, Freeman RH, et al. Separate renal function studies in conscious dogs with renovascular hypertension.Am J Physiol 1978;235:F310–F316.PubMedGoogle Scholar
  14. 14.
    Jackson B, McGrath BP, Matthews PG, et al. Differential renal function during angiotensin converting enzyme inhibition in renovascular hypertension.Hypertension 1986;8:650–654.PubMedGoogle Scholar
  15. 15.
    Hall JE, Guyton AC, Jackson TE, et al. Control of glomerular filtration rate by renin-angiotensin system.Am J Physiol 1977;233:F366–F372.PubMedGoogle Scholar
  16. 16.
    Hricik DE, Browning PJ, Kopelman R, et al. Captoprilinduced functional renal insufficiency in patients with bilateral renal-artery stenosis or renal-artery stenosis in a solitary kidney.N Engl J Med 1983;308:377–381.PubMedGoogle Scholar
  17. 17.
    Mackay A, Boyle P, Brown JJ, et al. The decision on surgery in renal artery stenosis.Q J Med 1983;51:363–381.Google Scholar
  18. 18.
    Case DB, Atlas SA, Marion RM, et al. Long-term efficacy of captopril in renovascular and essential hypertension.Am J Cardiol 1982;49:1440–1446.PubMedGoogle Scholar
  19. 19.
    Vaughan ED. Renovascular hypertension.Kidney Int 1985; 27:811–827.PubMedGoogle Scholar
  20. 20.
    Mueller FB, Sealey JE, Case DB, et al. The captopril test for identifying renovascular disease in hypertensive patients.Am J Med 1986;80:633–644.PubMedGoogle Scholar
  21. 21.
    Krakoff L, Ribeiro AB, Gorkin JU, Felton KR. Saralasin infusion for screening patients for renovascular hypertension.Am J Cardiol 1980;45:609–613.PubMedGoogle Scholar
  22. 22.
    Luft FC, Grim CE, Weinberger MH. Intervention in patients with renovascular hypertension and renal insufficiency.J Urol 1983;130:654.PubMedGoogle Scholar
  23. 23.
    Case DB, Laragh JH. Reactive hyperreninemia following angiotensin blockade with either saralasin or converting enzyme inhibitor: A new approach to screen for renovascular hypertension.Ann Intern Med 1979;91:153–160.PubMedGoogle Scholar
  24. 24.
    Wilcox CS, Williams CM, Smith TB, et al. Diagnostic uses of angiotensin-converting enzyme inhibitors in renovascular hypertension.Am J Hypertens 1988;1:344s–349s.PubMedGoogle Scholar
  25. 25.
    Marks LS, Maxwell MH, Varady PD. Renovascular hypertension: Does the renal vein renin ratio predict operative results?J Urol 1976;115:365–368.PubMedGoogle Scholar
  26. 26.
    Dustan HP, Humphries AW, de Wolfe VG, Page IH. Normal arterial pressure in patients with renal arterial stenoses.JAMA 1964;187:1028–1029.PubMedGoogle Scholar
  27. 27.
    Pickering TG, Sos TA, Vaughan ED Jr., et al. Predictive value and changes of renin secretion in patients undergoing successful renal angioplasty.Am J Med 1984;76:398–404.PubMedGoogle Scholar
  28. 28.
    Rudnick MR, Maxwell MH. Limitations of renin assays. In: Narins RG, ed.Controversies in Nephrology and Hypertension. New York. Churchill Livingstone, 1984:123–160.Google Scholar
  29. 29.
    Re R, Novelline R, Escourrou MT, et al. Inhibition of angiotensin-converting enzyme for diagnosis of renal-artery stenosis.N Engl J Med 1978;298:582.PubMedGoogle Scholar
  30. 30.
    Grim CE, Weinberger MH. Diagnosis of renovascular hypertension: The case for renin assays. In: Narins RG, ed.Controversies in Nephrology and Hypertension. New York: Churchill Livingstone 1984:109–122.Google Scholar
  31. 31.
    Strong CG, Hunt JC, Sheps SG. Renal venous renin activity enhancement of sensitivity of lateralization by sodium depletion.Am J Cardiol 1971;27:602–611.PubMedGoogle Scholar
  32. 32.
    Nally JV Jr, Clarke HS Jr, Grecos GP, et al. Effect of captopril on99mTc-diethylenetriaminepentaacetic acid renograms in two-kidney, one clip hypertension.Hypertension 1986;8:685–693.PubMedGoogle Scholar
  33. 33.
    Geyskes G, Oei HY, Puylaert CB, Mees EJ. Renovascular hypertension identified by captopril-induced changes in the renogram.Hypertension 1987;9:451–458.PubMedGoogle Scholar
  34. 34.
    Wollenweber J, Sheps SG, Davis DG. Clinical course of atherosclerotic renovascular disease.Am J Cardiol 1968; 21:60–71.PubMedGoogle Scholar
  35. 35.
    Hollenberg NK. Medical therapy for renovascular hypertension: A review.Am J Hypertens 1988;1:338s–343s.PubMedGoogle Scholar
  36. 36.
    Davis BA, Crook JE, et al. Prevalence of renovascular hypertension in patients with grade II or IV hypertensive retinopathy.N Engl J Med 1979;301:1273–1276.PubMedGoogle Scholar
  37. 37.
    Reams GP, Bauer JH, Gaddy P. Use of the converting enzyme inhibitor enalapril in renovascular hypertension: Effect on blood pressure, renal function and the reninangiotensin-aldosterone system.Hypertension 1986;8:290–297.PubMedGoogle Scholar
  38. 38.
    Franklin SS, Smith RD. Comparison of effects of enalapril plus hydrochlorothiazide versus standard triple therapy on renal function in renovascular hypertension.Am J Med 1985;79:14–23.Google Scholar
  39. 39.
    Hodsman GP, Brown JJ, Davies DL, et al. Convertingenzyme inhibitor enalapril (MK421) in treatment of hypertension with renal artery stenosis.Br Med J 1982;285:1697–1699.Google Scholar
  40. 40.
    Textor SC, Novick A, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease.Ann Intern Med 1985;102:309–314.Google Scholar
  41. 41.
    Hricik DE. Captopril-induced renal insufficiency and the role of sodium balance.Ann Intern Med 1985;103:222–223.PubMedGoogle Scholar
  42. 42.
    Schreiber MJ, Pohl MA, Novick AC. The natural history of atherosclerotic and fibrous renal artery disease.Urol Clin North Am 1984;11:383–392.PubMedGoogle Scholar
  43. 43.
    Michel JB, Dussaule JC, Choudat L, et al. Renal damage induced in the clipped kidney of one-clip, two-kidney hypertensive rats during normalization of blood pressure by converting enzyme inhibition.Kidney Int 1987;31 (Suppl 20): S168–S172.Google Scholar
  44. 44.
    Textor SC, Smith-Powell L. Loss of glomerular volume beyond arterial stenosis during chronic ACE inhibition in conscious aortic coarct rats.Clin Res 1987;35:138A.Google Scholar
  45. 45.
    Textor SC. Pathophysiology of renovascular hypertension.Urol Clin North Am 1984;11:373–381.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1990

Authors and Affiliations

  • Stephen C. Textor
    • 1
  1. 1.Division of Hypertension and Internal MedicineMayo ClinicRochesterUSA

Personalised recommendations