The effect of ACE inhibitors and other antihypertensive agents on insulin resistance

stenosis. For the individual patient rather than the individual kidney the outcome will depend on the patency of the contralateral renal artery. An intervention to decrease the rate progression of both the renal artery lesion and the decline in renal function in an individual kidney would appear attractive. At the present time there are no prospective studies to support either surgical or angioplasty intervention demonstrating increased longevity or reduction in rate of loss of renal function. Studies are, however, under way which may answer this question. The decision to perform angioplasty in a kidney with 60% or greater renal artery stenosis would appear reasonable as the likelihood of progression is high. This decision cannot be supported as yet by any outcome data in terms of patient survival or stabilization of renal function. In dialysis-dependent patients and those with 'flash pulmonary oedema' there are clear indications for intervention and not the 'wait-and-see' approach. The difficult group is those patients picked up on routine angiography of another vascular bed. It is tempting to suggest that measures such as low-dose aspirin and/or lipid-lowering therapy should be used in these patients. No studies have addressed this problem, and the 'waitand-see' approach may be entirely appropriate in the asymptomatic patients until data can demonstrate an improved outcome on therapy. 589