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
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