ReviewAtherosclerotic renal artery stenosis: how big is the problem, and what happens if nothing is done?Textor, Stephen CAuthor Information Mayo Clinic College of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA Correspondence and requests for reprints to Stephen C. Textor, MD, Division of Nephrology and Hypertension, West 9 A, Mayo Clinic, Rochester, MN 55905, USA. Tel: +1 507 284 4841; fax: +1 507 284 1161; e-mail: [email protected] Journal of Hypertension: October 2005 - Volume 23 - Issue - p S5-S13 doi: 10.1097/01.hjh.0000192096.83302.02 Buy Metrics Abstract Renal artery stenosis is a common problem, particularly for patients with other manifestations of atherosclerosis. Wide practice variations are apparent regarding how best to manage this disorder. Part of this variation is based on a broad range of clinical presentation, from incidentally identified disease of no clinical importance to rapidly progressive hypertension, renal failure, and refractory congestive heart failure. Advances in antihypertensive therapy, particularly as a result of angiotensin-converting enzyme inhibition and angiotensin receptor blockade, have led to improved blood pressure control and delayed recognition of renal artery disease. As a result, patients now sent for revascularization are older than before and have high comorbid disease risk, primarily related to cardiovascular events. Clinicians need to be vigilant for evidence of unsuspected renal artery stenosis as a cause of treatment-resistant hypertension and/or renal failure. Renal revascularization should be considered in viable individuals before the development of advanced renal insufficiency. © 2005 Lippincott Williams & Wilkins, Inc.