What Is the Treatment of Renal Artery Atherosclerosis? First-Line Evidence-Based Protocol

Renal artery atherosclerosis (atherosclerotic renovascular disease, ARVD) is a vascular manifestation of systemic atherosclerosis involving the renal arteries. First-line management targets cardiovascular risk reduction alongside blood pressure control, following guideline-recommended thresholds from multiple major societies.

Clinical Target

Blood pressure controlled to <130/80 mm Hg — with a systolic target of <120 mm Hg per KDIGO recommendations.

Treatment Approach (Partial Overview)

Intensive antihypertensive therapy is central, with a specific guideline-preferred class of agents recommended as first choice. This is combined with lipid management and antiplatelet therapy as part of a broader secondary prevention strategy. Full agent selection, sequencing, and additional interventions are detailed in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1053/j.ajkd.2021.06.025

Intensive management of arterial hypertension is the single most important and modifiable cardiovascular risk factor, with the latest American Heart Association/American College of Cardiology and European Society of Cardiology guidelines recommending a target blood pressure <130/80 mm Hg and KDIGO recommending systolic blood pressure <120 mm Hg.

Initial antihypertensive therapy often includes multiple drugs, but RAAS blockers are preferred.

Hence, RAAS blockade is recommended in the setting of ARVD.

Lipid-lowering drugs are strongly recommended to achieve cholesterol targets appropriate to the level of cardiovascular risk; by definition, ARVD represents a clinical manifestation of atherosclerotic disease and should be considered to pose very high risk.

Antiplatelet therapy with at least a low dose of aspirin is also considered as standard care for secondary prevention of cardiovascular events.

Additional measures to manage ARVD risk include tobacco cessation and glycemic control.

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