Impact of renal artery stenosis on renovascular hypertension and the therapeutic role of renal artery stenting: a comprehensive review.

Abstract

Background Renal artery stenosis (RAS) is characterized by reduced renal perfusion, activating the renin-angiotensin-aldosterone system (RAAS), which can lead to secondary hypertension, ischemic nephropathy, and cardiac destabilization syndrome. These conditions have significant healthcare implications. Renovascular hypertension (RVH) in RAS patients can be managed through medical therapy and revascularization, either endovascular or surgical. While renal artery stenting (RAS) was once viewed as the most effective treatment for atherosclerotic renovascular disease, recent trials suggest no significant difference in RVH management between medical therapy alone and combined with renal artery stenting. However, certain subgroups have exhibited favorable outcomes in blood pressure control post-stenting. Summary This comprehensive review synthesizes data, including findings from the HERCULES trial, which showed a reduction in blood pressure from 162.3±18.5/77.7±11.5 mmHg to 145.7±20.7/75.4±11.0 mmHg over 36 months (P<0.0001). Additionally, the ASPIRE-2 study demonstrated significant decreases in blood pressures from 168±25/82±13 mmHg to 149±25/77±12 mmHg at 24 months (P<0.001). The review delves into the prevalence, pathophysiology, clinical manifestations, diagnosis, and treatment of RAS-related RVH, specifically analyzing the efficacy and safety of renal artery stenting. Key Messages The analysis indicates that renal artery stenting may be particularly advantageous for certain patient subgroups, enhancing blood pressure outcomes and overall clinical status. Nevertheless, the criteria for selecting candidates for this intervention remain under debate. Future research should focus on high-risk RAS patients to explore long-term benefits and refine the utilization of renal artery stents, ultimately improving RVH management.