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Atherosclerotic renal artery stenosis (ARAS) is commonly seen in individuals with vascular disease in other territories, that is, coronary and cerebrovascular disease.1 Epidemiological data suggest that ARAS is present in ~7% of patients over the age of 65 years and in more than half of the patients with evidence of atherosclerosis elsewhere such as abdominal aortic aneurysm, peripheral vascular disease and multivessel coronary artery disease.
The overall goals of therapy in ARAS is normalisation of blood pressure, improvement of renal function, and reduction of the risk of cardiovascular and cerebrovascular events. Among those with existing cardiovascular disease, an important objective is reduction of future adverse events. Optimal management of individuals with ARAS should include lifestyle and pharmacological modification of cardiovascular risk factors, including blood pressure control with effective drugs, evidence-based use of antiplatelet therapy and statins. The important question for clinicians then becomes which individuals are likely to have incremental benefit from renal artery revascularisation beyond such therapies.
In this issue of the journal, Nakajima et al 2 attempt to identify clinical and echocardiographic factors associated with improvements of cardiac symptoms after renal artery stenting. Since the initial description of renal artery stenting, there have been multiple contrasting studies on the benefits of renal artery revascularisation. In general, retrospective, and uncontrolled studies have suggested benefit, while rigorous randomised studies have shown a lack …
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