NEPHROLOGY - ORIGINAL PAPER Long-term safety and efficacy of renin–angiotensin blockade in atherosclerotic renal artery stenosis Sofia Sofroniadou • Theodoros Kassimatis • Rajaventhan Srirajaskanthan • John Reidy • David Goldsmith Received: 11 August 2011 / Accepted: 10 November 2011 / Published online: 30 November 2011 Ó Springer Science+Business Media, B.V. 2011 Abstract Purpose The activation of the renin–angiotensin– aldosterone system caused by renal ischaemia in atherosclerotic renal artery stenosis (ARAS) may be responsible for serious cardiovascular and renal con- sequences. The aim of the study was to assess the long- term safety, tolerability and outcomes of the use of angiotensin I-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in patients with ARAS. Methods Thirty-six patients with angiographically defined ARAS (managed either with revascularization or only with medical treatment) were prospectively assessed for the safety, tolerability and outcomes of the use of ACEis or ARBs. Results The mean period of follow-up was 88.9 ± 37.8 months. A statistically significant reduction in systolic and diastolic blood pressure was recorded over time (P \ 0.001). While estimated glomerular filtration rate remained almost stable during the study period (0.816), nuclear EDTA-GFR showed a signif- icant reduction over time (P = 0.03). Mean time from diagnosis/intervention to end-stage renal disease for the cohort of 36 patients was 165.38 ± 13.62 months. Mean overall patient survival was 135.36 ± 15.25 months, with fourteen deaths (38.8%) occurring during the observational period. ACEi/ARB therapy was discontinued transiently in only 4 subjects. Conclusions The use of ACEis/ARBs is safe and effective in patients with ARAS independently of any parameters. Keywords Angiotensin I-converting enzyme inhibitors Á Angiotensin receptor blockers Á Renal artery stenosis Á Hypertension Introduction The prevalence of atherosclerotic renal artery stenosis (ARAS) in the hypertensive population ranges from 1% to 5% [1, 2]. The incidence of ARAS increases with age, and it can affect almost 7% of patients over 65 years of age [3]. One of the most important implications of the presence of ARAS is the high risk of subsequent cardiovascular events due to the coex- istence of vascular disease in coronary and other arterial beds [4–8]. Thus, as well as knowing how, when and whether to undertake any intervention to relieve partly or completely obstructed renal arteries (something which ASTRAL has helped significantly to clarify [9]), it is also important to optimize medical therapy to reduce cardiovascular risk, thereby S. Sofroniadou Á T. Kassimatis Á R. Srirajaskanthan Á J. Reidy Á D. Goldsmith (&) Department of Renal Medicine and Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners AHSC, London SE1 9RT, UK e-mail: david.goldsmith@gstt.nhs.uk 123 Int Urol Nephrol (2012) 44:1451–1459 DOI 10.1007/s11255-011-0091-y