Safety of angiotensin-converting enzyme inhibitors in patients with bilateral renal artery stenosis following successful renal artery stent revascularization

Sandeep Khosla, Aziz Ahmed, Mumtaz Siddiqui, Atul Trivedi, Daniel Benatar, Yasser Salem, Monther Elbzour, Vasundhra Vidyarthi, David Lubell

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Angiotensin-converting enzyme inhibitors (ACEIs) are contraindicated in patients with bilateral renal artery stenosis due to risk of azotemia resulting from preferential efferent arteriolar vasodilation in the renal glomerulus due to inhibition of angiotensin II. Patients with renal artery stenosis who can derive survival benefit from ACE inhibition, therefore, may not receive ACEI therapy. We evaluated the safety of ACEI therapy in patients with bilateral renal artery stenosis following successful revascularization using renal artery stenting. This study is a retrospective analysis of 25 patients who underwent bilateral renal artery stenting for refractory hypertension and had a strong clinical indication for long-term ACEI use (left ventricular dysfunction or diabetes). Eighteen of the 25 patients (72%) have been safely maintained on a target dose of ACEIs, 2 of the 25 have been treated with angiotensin receptor blockers due to cough, and 5 of the 25 are being treated with a hydralazine/nitrate combination due to cough (2 patients) or baseline renal insufficiency (3 patients). We conclude that patients with bilateral renal artery stenoses that have been successfully revascularized using renal stenting may be safely treated with long-term ACEI therapy.

Original languageEnglish
Pages (from-to)306-308
Number of pages3
JournalAmerican Journal of Therapeutics
Volume13
Issue number4
DOIs
StatePublished - Jul 2006
Externally publishedYes

Keywords

  • ACE inhibitors
  • Renal hypertension
  • Renovascular disease
  • Stent

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