ACE Inhibitors and Renal Artery Stenosis.

ACE inhibitor-induced renal dysfunction can suggest underlying bilateral renal artery stenosis (RAS), but this relation has not been studied prospectively. This study from a Dutch referral center enrolled 108 hypertensive patients at high risk for bilateral RAS (i.e., most had other evidence of vascular disease, mildly elevated creatinine, or poorly controlled blood pressure despite multiple-drug therapy).

While continuing other classes of drugs, the patients were given enalapril with close monitoring of plasma creatinine, and all eventually had renal angiography. Of 69 patients with a rise in plasma creatinine of at least 20 percent during the first two weeks of enalapril therapy, 52 had severe bilateral RAS (at least 50 percent stenosis bi…