Controversial Treatment of Atherosclerotic Renal Vascular Disease

Abstract

A therosclerotic renal artery stenosis (RAS) is a relatively common problem, affecting from 1% to 5% of patients with hypertension. 1,2 Given the high prevalence of hypertension, it follows that there are from 2 million to 4 million individuals with RAS in the United States alone. Autopsy data demonstrate that the incidence of RAS increases with age affecting 18% of individuals between the ages 65 to 74 years and Ͼ40% of those more than age 75. 3 RAS is also common in individuals with vascular disease in other beds and is present in Յ40% of those with overt coronary artery disease, aortoiliac disease, or peripheral vascular disease. 4 -6 At present, the best treatment for RAS is unknown, and, in particular, whether or not revascularization, typically accomplished by angioplasty and stenting, improves clinical outcomes for patients with RAS is unclear. Nevertheless, it is estimated that Ϸ40 000 renal artery angioplasties procedures are performed in the United States each year, which, depending on whether or not the procedure is beneficial, is either far too many or far too few. The purpose of this article is to review current knowledge about atherosclerotic RAS and to discuss the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, which is examining the best treatment for this disease.

The Year in Hypertension

“…The topics include atherosclerotic renovascular disease and related ongoing trials (107), clinical aspects of chronic hypertension in pregnancy (108), isolated systolic hypertension in the elderly (109), a review of the presentation and clinical diagnosis and treatment of pheochromocytoma (110,111), the effects of nonsteroidal antiinflammatory drugs on BP (112), the role of the sympathetic nervous system in the pathogenesis of metabolic syndrome (113), and the eye in hypertension (114), along with a comprehensive seminar in hypertension (115).…”

Angiotensin receptor blockade has protective effects on the poststenotic porcine kidney

“…4, 5 However, abundant evidence has shown that in most patients these drugs are well tolerated. 6 Conceivably, chronic blockade of RAAS might also blunt deleterious processes in the kidney, such as microvascular remodeling that characterizes ischemic kidney damage, 7, 8 and may modulate oxidative stress and inflammation as observed in other forms of CKD.…”

Grand Rounds at the British Hypertension Society: renal artery stenosis

“…15 In the CORAL trial, the definition of stenosis is narrowing of greater than 60%. We presume that the CORAL results will be stratified by degree of stenosis since it is our view that 60% stenosis might not be sufficient to define a haemodynamically significant lesion.…”