title: Atherosclerotic Renal Artery Stenosis and Hypertension: Pragmatism, Pitfalls, and Perspectives.
abstract: For many years and even decades, a diagnostic work-up to look for a secondary form of hypertension, particularly of renovascular origin, has been a central tenet in medicine. Atherosclerotic renal artery stenosis is considered the most common cause of renovascular hypertension. However, advances in understanding the complex pathophysiology of this condition and the recently documented futility of renal revascularization bring into question whether atherosclerotic renal artery stenosis truly causes "renovascular hypertension." From a clinical point of view, a clear distinction should be made between hypertension associated with atherosclerotic renal artery stenosis and hypertension caused by renal artery stenosis-induced activation of the renin-angiotensin-aldosterone system. Most patients with atherosclerotic renal artery stenosis do not have a form of hypertension that is remediable or improved by angioplasty; to expose them to the cost, inconvenience, and risk of a diagnostic work-up add up to little more than a wild goose chase. However, with very few exceptions, medical therapy with antihypertensives and statins remains the cornerstone for the management of patients with atherosclerotic renal artery stenosis and hypertension.
authors.affiliation: Mount Sinai St. Luke's & Roosevelt Hospitals, New York, NY.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bavishi
authors.affiliation: Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands; Orbis Medical Center, Sittard, The Netherlands.
authors.forename: Peter W
authors.initials: PW
authors.lastname: de Leeuw
authors.affiliation: Mount Sinai Medical Center, New York, NY. Electronic address: messerli.f@gmail.com.
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006978:Hypertension, Renovascular / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Atherosclerotic renal artery stenosis; Hypertension; Renal revascularization