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Lack of Evidence on Treatment for Narrowed Kidney Arteries

Increasing numbers of patients with narrowed kidney arteries are undergoing vessel-widening angioplasty and placement of a tubular stent//, but the latest scientific evidence does not show a clear advantage of that treatment over prescription drug therapy, according to a new review funded by the Agency for Healthcare Research and Quality. An article based on the review is posted today in the online version of the Annals of Internal Medicine.

Narrowed kidney arteries – a condition known as renal artery stenosis (RAS) – are the most common cause of correctable high blood pressure. The progressive condition reduces the supply of blood to the kidneys. In most cases the problem is caused by atherosclerosis, the gradual build-up of fat-containing plaque. RAS may occur alone or in combination with high blood pressure and chronic kidney disease. It is found in about 30 percent of patients with coronary artery disease and up to 50 percent of seniors or people who have diffuse atherosclerotic vascular diseases.

RAS patients have three treatment options: angioplasty, which reopens the narrowed artery with a small balloon; angioplasty in combination with a stent, a metal mesh tube placed inside the artery; or therapy with drugs, such as angiotensin converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), calcium channel blockers, and/or beta blockers. Some doctors also recommend statins to lower cholesterol, or antiplatelet medicines, such as aspirin. Patients treated only with drugs, which may need to be taken for a lifetime, can experience diminished kidney function due to RAS. That can lead to sickness and death, and these patients may be at increased risk of heart disease. However, it is unclear whether angioplasty leads to better outcomes for most patients.

While many RAS patients are treated with drugs, a growing number of RAS patients are opting for angioplasty. Medicare data show that angioplasty more than doubled f
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