ACEI for renovascular HTN?

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Page 317 of step-up medicine says ACEI are contraindicated in pts with reno HTN.

Page 318 of step-up medcine says ACEI can be used a conservative medical therapy.

So which is right?

 

[MonkeyRalph]

I think I remember something like ACEI are ok for unilateral renal artery stenosis, but are contraindicated in bilateral renal artery stenosis. Maybe that's where the confusion lies? I'm not sure though.

 

[jdh71]

I think I remember something like ACEI are ok for unilateral renal artery stenosis, but are contraindicated in bilateral renal artery stenosis. Maybe that's where the confusion lies? I'm not sure though.

right. you want as much renal blood flow as possible. remember angiotensin II increases GFR by constricting efferent arteriole and relaxing the afferent arteriole. In DM2 and essential HTN we use the ACEI because by doing so we decrease the damage to the kidney secondary to increased flow under pressure. But in the special case of renal HTN, you've got an obstruction proximal to the kidney itself and anything that will help keep up the GFR is wanted around, namely ATII, therefore NO ACEI