title: Renal artery stenosis-when to screen, what to stent?
abstract: Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed.
authors.affiliation: Medicines Monitoring Unit and Hypertension Research Centre, Ninewells Hospital and University of Dundee, Dundee, DD1 9SY, UK, claudine@memo.dundee.ac.uk.
authors.forename: Claudine G
authors.initials: CG
authors.lastname: Jennings
authors.forename: John G
authors.initials: JG
authors.lastname: Houston
authors.forename: Alison
authors.initials: A
authors.lastname: Severn
authors.forename: Samira
authors.initials: S
authors.lastname: Bell
authors.forename: Isla S
authors.initials: IS
authors.lastname: Mackenzie
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Macdonald
mesh_terms: D017130:Angioplasty / Q000379:methods; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000150:complications / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D015607:Stents
chemical_list: D000959:Antihypertensive Agents
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