Abstract
Atherosclerotic renal artery stenosis was considered a treatable cause of secondary hypertension, especially after development of angioplasty and stents. However, randomized trials have not proven either blood pressure or renal function improvement in patients treated with revascularization over conservative treatment with antihypertensives, statins and anti-aggregation therapy.
On the other hand, these studies face substantial criticism because they included patients with low grade of stenosis and uncomplicated clinical course of hypertension or renal function. Active screening and treatment of atherosclerotic renal artery stenosis is thus not recommended.
Some subgroups of patients, e.g. with flash pulmonary oedema may profit from revascularization. Renal artery stenosis is not only a hemodynamic problem, it also activates pro-inflammatory and fibrosing processes in the renal tissue.
Following research should be directed at new drugs targeting these mechanisms.