Tullis et al. performed a cross-sectional analysis of the effect of usage vs non-usage of different

classes of antihypertensive medication on blood pressure control in a population of 139 hypertensive patients with atherosclerotic renal artery stenosis demonstrated by renal artery duplex ultrasonography (Table 2).24 The study found ACE inhibitor usage vs non-usage was associated with significantly lower systolic (157 ± 27 vs 169 ± 22 mmHg; P = 0.03) and diastolic (79 ± 9 vs 85 ± 9 mmHg; P = 0.001) blood pressure. In contrast, usage vs non-usage selleck of beta-blockers or calcium channel blockers did not have any significant effect on blood pressure. Blood pressure was actually slightly higher in users of diuretics compared with non-users. The observed beneficial effect of ACE inhibitor use on blood pressure was confined to those patients with at least one high-grade (>60%) renal artery stenosis lesion Talazoparib supplier and was more pronounced in those with unilateral rather than bilateral high-grade disease. A multiple regression analysis model predicted an 11.2 mmHg reduction in mean arterial pressure in patients with high-grade unilateral renal artery stenosis who were taking an ACE inhibitor, compared with those who were not. In summary, this study supports the concept that using medications

that block the renin–angiotensin system provides superior control of blood pressure than do alternative agents in patients with renovascular hypertension. This study is limited, however, by its cross-sectional observational design and its lack of data regarding either renal function or clinical outcomes. Several open label studies have found that ACE inhibitors can successfully control blood pressure in a high proportion (82–96%) of patients with

renovascular triclocarban hypertension (Table 3). This is a contrast to the era before ACE inhibitors were available, when renovascular hypertension was commonly refractory to the available medical therapies.25 In addition, in a review of 269 patients with documented renovascular hypertension treated with captopril in worldwide hypertension trials, Hollenberg reported that control of hypertension (diastolic pressure  < 95 mmHg) was achieved in 74% of patients.25 Renal failure necessitating cessation of captopril only occurred in 5% of these patients. The response of renovascular hypertension to captopril has also been reported to be predictive of the effectiveness of surgical revascularization in improving blood pressure.26,27 Hodsman et al. treated 20 patients with renovascular hypertension with enalapril and was able to successfully lower blood pressure in all 20 patients with no significant adverse effects.28 Jackson et al. also reported that enalapril (±a diuretic) was able to achieve a satisfactory reduction in blood pressure in a high proportion (75%) of patients with proven renovascular hypertension.