Use of renin-angiotensin inhibitors in people with renal artery stenosis

Clin J Am Soc Nephrol. 2014 Jul;9(7):1199-206. doi: 10.2215/CJN.11611113. Epub 2014 Jun 5.


Background and objectives: People with atherosclerotic renal artery stenosis may benefit from renin-angiotensin inhibitors, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers, but little is known about the factors associated with their use.

Design, setting, participants, & measurements: The Cardiovascular Outcomes in Renal Atherosclerotic Lesions study ( identified: NCT00081731) is a prospective, international, multicenter clinical trial that randomly assigned participants with atherosclerotic renal artery stenosis who received optimal medical therapy to stenting versus no stenting from May 2005 through January 2010. At baseline, medication information was available from 853 of 931 randomly assigned participants. Kidney function was measured by serum creatinine-based eGFR at a core laboratory.

Results: Before randomization, renin-angiotensin inhibitors were used in 419 (49%) of the 853 participants. Renin-angiotensin inhibitor use was lower in those with CKD (eGFR<60 ml/min per 1.73 m(2)) (58% versus 68%; P=0.004) and higher in individuals with diabetes (41% versus 27%; P<0.001). Presence of bilateral renal artery stenosis or congestive heart failure was not associated with renin-angiotensin inhibitor use. Although therapy with renin-angiotensin inhibitors varied by study site, differences in rates of use were not related to the characteristics of the site participants. Participants receiving a renin-angiotensin inhibitor had lower systolic BP (mean ± SD, 148 ± 23 versus 152 ± 23 mmHg; P=0.003) and more often had BP at goal (30% versus 22%; P=0.01).

Conclusions: Kidney function and diabetes were associated with renin-angiotensin inhibitor use. However, these or other clinical characteristics did not explain variability among study sites. Patients with renal artery stenosis who received renin-angiotensin inhibitor treatment had lower BP and were more likely to be at treatment goal.

Keywords: ACE inhibitors; blood pressure; renal artery stenosis.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Atherosclerosis / diagnosis
  • Atherosclerosis / drug therapy
  • Atherosclerosis / ethnology
  • Atherosclerosis / physiopathology
  • Atherosclerosis / therapy*
  • Blood Pressure / drug effects
  • Comorbidity
  • Female
  • Glomerular Filtration Rate / drug effects
  • Humans
  • Kidney / drug effects
  • Kidney / physiopathology
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Artery Obstruction / diagnosis
  • Renal Artery Obstruction / drug therapy
  • Renal Artery Obstruction / ethnology
  • Renal Artery Obstruction / physiopathology
  • Renal Artery Obstruction / therapy*
  • Renin-Angiotensin System / drug effects*
  • Risk Factors
  • Stents
  • Treatment Outcome
  • United States / epidemiology


  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors

Associated data