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Blockade of the Renin-Angiotensin System in Hypertensive Patients with Atherosclerotic Renal Artery Stenosis

  • Hypertension Management and Antihypertensive Drugs (HM Siragy and B Waeber, Section Editors)
  • Published:
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Abstract

Renin angiotensin system (RAS) blockers are generally considered as contraindicated when an atheromatous renal artery stenosis (ARAS) is diagnosed. The main reason is the fear of inducing renal ischemia and, hence, accelerating renal fibrosis and the progression towards end stage renal disease, albeit RAS blocker have been shown to be highly effective in controlling blood pressure. Part of the solution came by the development of the revascularization. There is now growing evidence showing no superiority of angioplasty over medical treatment on cardiovascular events and mortality, renal function and blood pressure control. Hence, RAS blockers resurfaced based on their proven beneficial effects on blood pressure control and cardiovascular prevention in high risk atherosclerotic patients. Thus, RAS blockers belong today to the standard treatment of hypertensive patients with ARAS. However they were not systematically prescribed in trials focusing on ARAS. The ongoing CORAL trial will give us further information on the place of this class of antihypertensive drugs in patients with ARAS.

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Acknowledgments

Menno Pruijm and Michel Burnier are supported by a grant from the Swiss National Science Foundation (FN 32003B-132913).

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Faical Jarraya, Menno Pruijm, Gregoire Wuerzner, and Michel Burnier declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Nephrology department, Hedi Chaker University Hospital, Sfax, 3029, Tunisia

    Faical Jarraya

  2. Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland

    Menno Pruijm, Gregoire Wuerzner & Michel Burnier

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  1. Faical Jarraya
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Jarraya, F., Pruijm, M., Wuerzner, G. et al. Blockade of the Renin-Angiotensin System in Hypertensive Patients with Atherosclerotic Renal Artery Stenosis. Curr Hypertens Rep 15, 497–505 (2013). https://doi.org/10.1007/s11906-013-0376-x

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