Treatment
Renal hypoperfusion activates renin-angiotensin-aldosterone (RAA) axis; ACE inhibitors and angiotensin II receptor blocker classes of antihypertensives are contraindicated as they might compromise the renal function especially if the stenosis is bilateral. Nitroprusside, labetalol, or calcium antagonists are generally effective in lowering blood pressure acutely, although inhibitors of the RAA axis are most effective long-term treatment, if disease is not bilateral.
Surgical revascularization appears to be superior for ostial lesions characteristic of atherosclerosis. The relative efficacy of surgery compared with angioplasty (especially with stenting) for fibromuscular dysplasia or for non-occlusive, non-ostial atherosclerotic disease is unclear. Angioplasty (with or without stenting) tends to be temporarily effective for some cases. However, as of early 2011, six randomized controlled trials have failed to demonstrate any real benefit in blood pressure control or preservation of renal function when using endovascular (angioplasty or stenting) procedures compared to medical therapy alone. ACE inhibitors or ARBs are ideal agents for hypertension associated with renal artery stenosis, except in patients with bilateral disease (see "Ischemic Nephropathy" below) or disease in a solitary kidney (including an allograft).
Read more about this topic: Renovascular Hypertension
Famous quotes containing the word treatment:
“To me, nothing can be more important than giving children books, It’s better to be giving books to children than drug treatment to them when they’re 15 years old. Did it ever occur to anyone that if you put nice libraries in public schools you wouldn’t have to put them in prisons?”
—Fran Lebowitz (20th century)
“Judge Ginsburg’s selection should be a model—chosen on merit and not ideology, despite some naysaying, with little advance publicity. Her treatment could begin to overturn a terrible precedent: that is, that the most terrifying sentence among the accomplished in America has become, “Honey—the White House is on the phone.””
—Anna Quindlen (b. 1952)
“[17th-century] Puritans were the first modern parents. Like many of us, they looked on their treatment of children as a test of their own self-control. Their goal was not to simply to ensure the child’s duty to the family, but to help him or her make personal, individual commitments. They were the first authors to state that children must obey God rather than parents, in case of a clear conflict.”
—C. John Sommerville (20th century)