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Clinical Crossroads
Clinician's Corner
November 5, 2008

An 82-Year-Old Woman With Worsening HypertensionReview of Renal Artery Stenosis

Author Affiliations

Author Affiliations: Dr Rosenfield is Lecturer on Medicine, Harvard Medical School, and Section Head, Vascular Medicine and Intervention, Division of Cardiology, Massachusetts General Hospital, Boston, and Dr Jaff is Associate Professor of Medicine, Harvard Medical School, and Medical Director, Massachusetts General Hospital Vascular Center, Boston.

JAMA. 2008;300(17):2036-2044. doi:10.1001/jama.300.13.jrr80009

Renal artery stenosis (RAS) is a common disorder in adults with atherosclerosis and is associated with hypertension, impaired renal function, congestive heart failure, and angina pectoris. The incidence of RAS is increasing because of the aging of the US population and increasing prevalence of atherosclerosis. The case of Mrs S, an 82-year-old woman with long-standing hypertension and unilateral RAS detected by magnetic resonance angiography, illustrates the challenges surrounding indications for revascularization. The discussion reviews the clinical presentation and natural history of RAS and strategies for diagnosis. The role of medical therapy, surgery, and endovascular therapy are reviewed, particularly in the context of guidelines and systematic reviews to help clinicians and patients facing this challenging decision.