From the Guidelines
Renal artery stenosis hypertension is not hereditary in most cases, and treatment should focus on controlling blood pressure with medications like ACE inhibitors or angiotensin receptor blockers, as recommended by the 2018 ESC guidelines 1. This condition occurs when one or both renal arteries narrow, reducing blood flow to the kidneys, which then activate the renin-angiotensin-aldosterone system to raise blood pressure. Unlike essential hypertension which often has a strong genetic component, renal artery stenosis is typically acquired through atherosclerosis (especially in older adults) or fibromuscular dysplasia (more common in younger women). Some key points to consider in the management of renal artery stenosis include:
- Medical therapy with ACE inhibitors or angiotensin receptor blockers is recommended for treatment of hypertension associated with unilateral renal artery stenosis, as stated in the 2018 ESC guidelines 1.
- Calcium channel blockers, beta-blockers, and diuretics are also recommended for treatment of hypertension associated with renal artery disease, as per the 2018 ESC guidelines 1.
- Revascularization procedures such as angioplasty with stenting may be necessary to restore blood flow in severe cases, particularly in patients with hypertension and/or signs of renal impairment related to renal arterial fibromuscular dysplasia, as suggested by the 2018 ESC guidelines 1.
- The American Heart Association also recommends that renal artery stenosis be considered in the diagnosis and management of resistant hypertension, and that revascularization may be beneficial in improving blood pressure control and reducing mortality, as stated in the 2018 scientific statement 1. While there may be rare genetic conditions that predispose to vascular abnormalities affecting the renal arteries, classic renal artery stenosis hypertension is not considered a hereditary condition. If multiple family members have hypertension, it's more likely to be essential hypertension rather than renal artery stenosis. In terms of specific treatment strategies, the use of ACE inhibitors or angiotensin receptor blockers is recommended as first-line therapy for patients with renal artery stenosis and hypertension, as supported by the 2018 ESC guidelines 1 and the 2018 American Heart Association scientific statement 1.
From the Research
Renal Artery Stenosis and Hypertension
- Renal artery stenosis is a common cause of secondary hypertension, which can occur due to unilateral or bilateral narrowing of the renal arteries or a solitary kidney with stenotic artery 2.
- This condition can lead to renal insufficiency, such as ischemic kidney disease, or pulmonary edema.
Diagnosis and Treatment
- Renal artery stenosis can be diagnosed using various modalities, including Doppler ultrasound, computed tomography angiography, magnetic resonance angiography, or selective angiogram 2.
- Treatment options include percutaneous angioplasty (with or without stenting) or open surgical approach revascularization, which have excellent primary patency rates 2.
- However, studies have shown that the long-term benefits of renal artery angioplasty or stenting in terms of blood pressure control and renal function are not substantial compared to pharmacological management 2, 3.
Management of Hypertension with Renal Artery Stenosis
- The management of atherosclerotic renal artery stenosis in patients with hypertension is controversial, and major clinical trials have failed to show significant benefits of revascularization over medical management 3.
- Medical management includes intensive correction of cardiovascular risk factors, and ACE inhibitors are probably second-line antihypertensives for patients with unilateral renal artery stenosis and two kidneys 4.
- Bilateral renal artery stenosis, or a unilateral stenosis in a patient with only one kidney, is an absolute contraindication to ACE inhibition 4.
Hereditary Factors
- There is no direct evidence in the provided studies to suggest that renal artery stenosis hypertension is hereditary.
- However, the studies focus on the diagnosis, management, and treatment of renal artery stenosis and its association with hypertension, rather than exploring hereditary factors.