Hypertensive Nephrosclerosis and Renovascular Disease — Viva Defence

Opening statement (SASPOP, delivered aloud)

"Mr Lawson is a 66-year-old man with established cardiovascular disease and genuinely resistant hypertension on two agents, complicated by a 25% creatinine rise since ramipril uptitration and an incidental 70% left renal artery ostial stenosis with preserved, symmetric kidney sizes. His main problems are: true resistance that needs its workup completed; a creatinine rise that is most consistent with the expected haemodynamic effect of ACE inhibition and is simultaneously a clue that the stenosis may be haemodynamically significant; diffuse atherosclerotic disease that drives his prognosis; and a decision — prompted by the surgical referral — about revascularisation, where the trial evidence supports optimal medical therapy. I would like to complete the resistant-hypertension evaluation, define the haemodynamic significance of the lesion, and agree a medical-first plan with him." [1] [3]