Survival of patients with renovascular disease and ACE inhibition

Aim: Renovascular hypertension (RVH) is associated with a high prevalence o f target organ damage and a high mortality. We have undertaken this follow- up study to assess the role played by comorbid conditions, and pharmacologi cal treatment on survival, and on renal function in 64 patients with diffus e atherosclerotic vascular and renovascular disease (RVD). Patients and met hods: The patients were followed for an average period of 37.3 +/- 20.4 mon ths. Results: At the end of the follow-up we found a cumulative survival at 5 years of 60% +/- 10. Cerebrovascular and cardiovascular disease were res ponsible for 92% of deaths. A decrease in creatinine clearance > 10 ml/min at 5 years was found in 65% of patients, 3 of whom ended in dialysis. Multi variate analysis of predictors of survival showed that treatment with angio tensin converting enzyme inhibitors (ACEi) was significantly associated wit h a favourable outcome (p = 0.019). Conversely, proteinuria had a negative effect. Renal survival was best predicted by the level of renal function at entry (p = 0.02), and was not influenced by pharmacological treatment. Con clusion: We conclude that ACEi exerts a beneficial effect on survival witho ut affecting renal function in patients with RVD due to unilateral renal st enosis.