Blood pressure, antihypertensive medication, and atherosclerotic renal artery stenosis

The relationship between atherosclerotic renal artery stenosis (ARAS) and blood pressure control remains poorly understood. Duplex ultrasonography is a noninvasive method for detecting and grading ARAS. The purpose of this study was to characterize the relationship between the degree of ARAS, levels of blood pressure, and control of blood pressure with antihypertensive medication. A cross-sectional analysis was performed on 139 patients with ARAS. All patients had at least one diseased renal artery by duplex ultrasound. Renal arteries were classified as normal, less than 60% stenosis, or 60% or greater (high-grade) stenosis. Data regarding blood pressure, coexisting risk factors, and medications were collected. The extent of ARAS was significantly associated with progressive elevation of the systolic blood pressure, whereas the diastolic component was elevated in the case of unilateral high-grade stenosis: no high-grade stenoses, 153 ± 22/81 ± 10 mm Hg; unilateral high-grade stenosis, 162 ± 22/86 ± 9 mm Hg; and bilateral high-grade stenoses, 174 ± 27/82 ± 9 mm Hg (P = 0.002 systolic; P = 0.02 diastolic). Eighty-two percent of the patients were taking known antihypertensive medications. Angiotensin-converting enzyme inhibitor (ACEI) usage versus nonusage was associated with a significantly lower systolic (157 ± 27 v 169 ± 22 mm Hg; P = 0.03) and diastolic (79 ± 9 v 85 ± 9 mm Hg; P = 0.001) blood pressure. The effect of ACEI usage was observed in patients with high-grade ARAS. None of the other classes of antihypertensive medications were associated with significantly lower blood pressure. In patients with ARAS, blood pressure levels were correlated with the severity of renal artery disease. Patients taking ACEIs had significantly lower blood pressures, and the effect of ACEI usage was strongest among patients with unilateral ARAS.