Safety of angiotensin-converting enzyme inhibitors in patients with bilateral renal artery stenosis following successful renal artery stent revascularization.
Angiotensin-converting enzyme inhibitors (ACEIs) are contraindicated in patients with bilateral renal artery stenosis due to risk of azotemia resulting from preferential efferent arteriolar vasodilation in the renal glomerulus due to inhibition of angiotensin II. Patients with renal artery stenosis who can derive survival benefit from ACE inhibition, therefore, may not receive ACEI therapy. We evaluated the safety of ACEI therapy in patients with bilateral renal artery stenosis following successful revascularization using renal artery stenting. This study is a retrospective analysis of 25 patients who underwent bilateral renal artery stenting for refractory hypertension and had a strong clinical indication for long-term ACEI use (left ventricular dysfunction or diabetes). Eighteen of the 25 patients (72%) have been safely maintained on a target dose of ACEIs, 2 of the 25 have been treated with angiotensin receptor blockers due to cough, and 5 of the 25 are being treated with a hydralazine/nitrate combination due to cough (2 patients) or baseline renal insufficiency (3 patients). We conclude that patients with bilateral renal artery stenoses that have been successfully revascularized using renal stenting may be safely treated with long-term ACEI therapy.
Khosla
Sandeep
S
Section of Cardiology, Department of Medicine, Rosalind Franklin University of Medicine & Science/The Chicago Medical School, North Chicago, and Mount Sinai Hospital, Chicago, Illinois 60606, USA. khos@sinai.org
Ahmed
Aziz
A
Siddiqui
Mumtaz
M
Trivedi
Atul
A
Benatar
Daniel
D
Salem
Yasser
Y
Elbzour
Monther
M
Vidyarthi
Vasundhra
V
Lubell
David
D
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003371:Cough / Q000139:chemically induced; D005260:Female; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000150:complications* / Q000188:drug therapy; D051437:Renal Insufficiency / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D014656:Vascular Surgical Procedures
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D006830:Hydralazine