An 82-year-old woman with worsening hypertension: review of renal artery stenosis.
Renal artery stenosis (RAS) is a common disorder in adults with atherosclerosis and is associated with hypertension, impaired renal function, congestive heart failure, and angina pectoris. The incidence of RAS is increasing because of the aging of the US population and increasing prevalence of atherosclerosis. The case of Mrs S, an 82-year-old woman with long-standing hypertension and unilateral RAS detected by magnetic resonance angiography, illustrates the challenges surrounding indications for revascularization. The discussion reviews the clinical presentation and natural history of RAS and strategies for diagnosis. The role of medical therapy, surgery, and endovascular therapy are reviewed, particularly in the context of guidelines and systematic reviews to help clinicians and patients facing this challenging decision.
Rosenfield
Kenneth
K
Harvard Medical School, and Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA. krosenfield@fastmail.us
Jaff
Michael R
MR
D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D014656:Vascular Surgical Procedures
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors