Behandling av aterosklerotisk njurartärstenos i förändring. Lågdos ACE-hämmare och angiotensinreceptorblockare motiverat i vissa fall
Engelsk titel: Treatment of atherosclerotic renal artery stenosis. Low dosage ACE inhibitors and angiotensin-receptor blockers are justified in certain cases
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Författare:
Alhadad A
;
Sterner G
;
Herlitz H
Email: alaa.alhadad@skane.se
Språk: Swe
Antal referenser: 52
Dokumenttyp:
Översikt
UI-nummer: 09101773
Sammanfattning
Renovascular hypertension (RVH) is the direct consequence of renal artery stenosis (RAS).
Most RAS patients have dis¬seminated atherosclerosis, with > 6 times greater risk of cardiovascular death than age-matched controls. Elevated levels of angiotensin II and aldosterone lead to detrimental effects both through hypertensive injury and activation of profibrotic and atherosclerotic pathways. The recent primary report from the ASTRAL study supports the conservative treatment in patients with non-severe RAS (on average 2.8 antihypertensive drugs). Consequently, many patients with RVH will be candidates for ACE inhibitor /ARB. In patients at risk of atherosclerotic RAS, treatment with ACE inhibitors may cause acute renal failure 1-14 days after the initiation of treatment with ACE inhibitors. Determination of serum creatinine is obligatory within two weeks after the administration of ACEi/AII blockers in patients with suspected RVH. In patients with severe hypertension in the presence of other atherosclerotic manifestations unilateral renal artery stenosis should be suspected and further investigated before treatment with ACEi/ARB is initiated.