Renal artery atherosclerosis (ARVD) and heart failure frequently coexist. This combination is clinically significant: the presence of heart failure alters the therapeutic approach to renal artery disease and requires careful coordination of management.
ARVD is highly prevalent in heart failure, occurring in 34% of acute hospitalizations with systolic HF in patients aged >70 years and in 54% of cases of HF in outpatients with CKD. Heart failure is therefore a central comorbidity shaping how renal artery atherosclerosis is managed.
Medical therapy draws on regimens established in heart failure, with RAAS blockade forming a central component — alongside additional measures targeting atherosclerotic risk. The specific agents, the clinical thresholds that govern their continuation, and the full structured algorithm are available in the complete protocol.
DOI: 10.1053/j.ajkd.2021.06.025
ARVD is highly prevalent in HF, occurring in 34% of acute hospitalizations with systolic HF in patients aged >70 years and in 54% of cases of HF in outpatients with CKD.
Medical therapy for ARVD encompasses many of the therapies established in HF, including RAAS blockade.
Although not specific to ARVD, it is recommended that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers be continued until an increase in serum creatinine level of 30%‑50% is noted or there is evidence of hemodynamic change or hyperkalemia.
Other drugs established for use in HF, such as β‑blockers and atherosclerotic secondary prevention with statins and aspirin, are also likely to be of benefit in ARVD.
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