ACE inhibitors in renovascular hypertension

ACE inhibition has provided many insights into the etiology and treatment of renovascular hypertension. Not only have studies using these agents profoundly expanded our understanding of the mechanisms governing preservation of renal perfusion pressures and function beyond arterial lesions, they have provided tools for more precise diagnosis and therapy in clinical practice. ACE inhibitors must be considered the agents of choice for the treatment of renovascular hypertension and provide an effective and safe medical alternative for many patients developing atherosclerotic renovascular lesions with an otherwise unacceptable risk for revascularization procedures. With the advent of widespread clinical use of these agents, however, come many new questions regarding the long-term fate of the kidney beyond vascular lesions and the need for preservation of renal function.