Editorial Use of Renin-Angiotensin System Blockade in Patients with Renal Artery Stenosis

In his work as a pathologist in the early 20th century, Harry Goldblatt recognized that patients with hy-pertension were exceptionally prone to renovascular sclerosis on autopsy. The renal lesions were more fre-quent and severe than the atherosclerotic changes appreciated in any other organ in these patients (1). He applied this notion to the development of his ani-mal models, which ultimately revealed a link between renovascular disease, hypertension, and humoral dys-regulation (2). Goldblatt demonstrated that clamping the renal artery (i.e., inducing renal ischemia) resulted in hypertension. However, simultaneously clamping the renal artery and renal vein yielded a normotensive response. He concluded that renal ischemia precipi-tated the release of a pressor substance into the circu