Long-term safety and efficacy of renin-angiotensin blockade in atherosclerotic renal artery stenosis

Purpose
The activation of the renin-angiotensin-aldosterone system caused by renal ischaemia in atherosclerotic renal artery stenosis (ARAS) may be responsible for serious cardiovascular and renal consequences. The aim of the study was to assess the long-term safety, tolerability and outcomes of the use of angiotensin I-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in patients with ARAS.

Methods
Thirty-six patients with angiographically defined ARAS (managed either with revascularization or only with medical treatment) were prospectively assessed for the safety, tolerability and outcomes of the use of ACEis or ARBs.

Results
The mean period of follow-up was 88.9 +/- A 37.8 months. A statistically significant reduction in systolic and diastolic blood pressure was recorded over time (P <0.001). While estimated glomerular filtration rate remained almost stable during the study period (0.816), nuclear EDTA-GFR showed a significant reduction over time (P = 0.03). Mean time from diagnosis/intervention to end-stage renal disease for the cohort of 36 patients was 165.38 +/- A 13.62 months. Mean overall patient survival was 135.36 +/- A 15.25 months, with fourteen deaths (38.8%) occurring during the observational period. ACEi/ARB therapy was discontinued transiently in only 4 subjects.

Conclusions
The use of ACEis/ARBs is safe and effective in patients with ARAS independently of any parameters.