title: Use of renin-angiotensin inhibitors in people with renal artery stenosis.
abstract: OBJECTIVE
  People with atherosclerotic renal artery stenosis may benefit from renin-angiotensin inhibitors, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers, but little is known about the factors associated with their use.
  
  
  METHODS
  The Cardiovascular Outcomes in Renal Atherosclerotic Lesions study (ClinicalTrials.gov identified: NCT00081731) is a prospective, international, multicenter clinical trial that randomly assigned participants with atherosclerotic renal artery stenosis who received optimal medical therapy to stenting versus no stenting from May 2005 through January 2010. At baseline, medication information was available from 853 of 931 randomly assigned participants. Kidney function was measured by serum creatinine-based eGFR at a core laboratory.
  
  
  RESULTS
  Before randomization, renin-angiotensin inhibitors were used in 419 (49%) of the 853 participants. Renin-angiotensin inhibitor use was lower in those with CKD (eGFR<60 ml/min per 1.73 m(2)) (58% versus 68%; P=0.004) and higher in individuals with diabetes (41% versus 27%; P<0.001). Presence of bilateral renal artery stenosis or congestive heart failure was not associated with renin-angiotensin inhibitor use. Although therapy with renin-angiotensin inhibitors varied by study site, differences in rates of use were not related to the characteristics of the site participants. Participants receiving a renin-angiotensin inhibitor had lower systolic BP (mean ± SD, 148 ± 23 versus 152 ± 23 mmHg; P=0.003) and more often had BP at goal (30% versus 22%; P=0.01).
  
  
  CONCLUSIONS
  Kidney function and diabetes were associated with renin-angiotensin inhibitor use. However, these or other clinical characteristics did not explain variability among study sites. Patients with renal artery stenosis who received renin-angiotensin inhibitor treatment had lower BP and were more likely to be at treatment goal.
authors.affiliation: Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio; Kaleigh.Evans@utoledo.edu.
authors.forename: Kaleigh L
authors.initials: KL
authors.lastname: Evans
authors.affiliation: Division of Nephrology, University of Washington School of Medicine, Providence Sacred Heart Medical Center, Spokane, Washington;
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Tuttle
authors.affiliation: Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio;
authors.forename: David A
authors.initials: DA
authors.lastname: Folt
authors.affiliation: Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio;
authors.forename: Taylor
authors.initials: T
authors.lastname: Dawson
authors.affiliation: Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio;
authors.forename: Steven T
authors.initials: ST
authors.lastname: Haller
authors.affiliation: Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio;
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Brewster
authors.affiliation: Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio;
authors.forename: Wencan
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, Michigan;
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jamerson
authors.affiliation: Division of Nephrology.
authors.forename: Lance D
authors.initials: LD
authors.lastname: Dworkin
authors.affiliation: Harvard Clinical Research Institute, Boston, Massachusetts; and.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
authors.affiliation: Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island;
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Murphy
authors.affiliation: Harvard Clinical Research Institute, Boston, Massachusetts; and.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.affiliation: University of Texas Health Science Center, San Antonio, Texas.
authors.forename: William
authors.initials: W
authors.lastname: Henrich
authors.affiliation: Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio;
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure / Q000187:drug effects; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: ACE inhibitors; blood pressure; renal artery stenosis