This Article Full Text Full Text (PDF) All Versions of this Article: 48/3/350    most recent 01.HYP.0000233513.19720.b7v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dworkin, L. D. Search for Related Content PubMed PubMed Citation Articles by Dworkin, L. D. Related Collections Congestive Peripheral vascular disease Other Treatment Angiography Computerized tomography and Magnetic Resonance Imaging

(Hypertension. 2006;48:350.)
© 2006 American Heart Association, Inc.

Brief Review

Controversial Treatment of Atherosclerotic Renal Vascular Disease

The Cardiovascular Outcomes in Renal Atherosclerotic Lesions Trial

From the Brown Medical School, Providence, Rhode Island.

Correspondence to Lance D. Dworkin, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. E-mail ldworkin@lifespan.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Atherosclerotic renal artery stenosis (RAS) is a relatively common problem, affecting from 1% to 5% of patients with hypertension.^1,2 Given the high prevalence of hypertension, it follows that there are from 2 million to 4 million individuals with RAS in the United States alone. Autopsy data demonstrate that the incidence of RAS increases with age affecting 18% of individuals between the ages 65 to 74 years and >40% of those more than age 75.³ RAS is also common in individuals with vascular disease in other beds and is present in 40% of those with overt coronary artery disease, aortoiliac disease, or peripheral vascular disease.^4–6 At present, the best treatment for RAS is unknown, and, in particular, whether or not revascularization, typically accomplished by angioplasty and stenting, improves clinical outcomes for patients with RAS is unclear. Nevertheless, it is estimated that &40 000 renal artery angioplasties procedures are performed in the United States each year, which, depending on whether or not the procedure is beneficial, is either far too many or far too few. The purpose of this article is to review current knowledge about atherosclerotic RAS and to discuss the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, which is examining the best treatment for this disease.

	Pathophysiology and Natural History

 
The pathophysiology of hypertension is different in patients with unilateral and bilateral RAS. In both, a drop in perfusion pressure to a kidney distal to a stenosis induces an increase in the activity of the renin–angiotensin–aldosterone system (RAAS). Salt and water retention and . . . [Full Text of this Article]

This article has been cited by other articles:

				B. Williams The Year in Hypertension J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1803 - 1817. [Full Text] [PDF]

				T. K. Alphons Wierema, A. A. Kroon, and P. W. de Leeuw Poor performance of diagnostic tests for atherosclerotic renal artery stenosis--discrepancies between stenosis and renal function Nephrol. Dial. Transplant., March 1, 2007; 22(3): 689 - 692. [Full Text] [PDF]