HDCN Article Review/Hyperlink

Himmelmann A, Hansson L, Hansson B-G, Hedstrand H, Skogstrom K, Ohrvik J, Furangen A

Long-term renal preservation in essential hypertension: angiotensin converting enzyme inhibition is superior to beta- blockade

Am J Hypertens (Sep) 9:850-853 1996

This study compared the effects of an ACE-inhibitor (cilazapril) vs a beta- blocker (atenolol) on the rate of decline in renal function (expressed as GFR as measured by 51- Cr-EDTA) in 257 elderly patients (mean age about 66 years) with hypertension (initial diastolic pressures beteen 95 and 115 mm Hg). The study was double-blind and initially lasted for 2 years. In the initial report, in Blood Pressure 4:85-90, 1995, a lesser decline in GFR was found in the cilazapril-treated group at 6 and 12 months, but no longer by 2 years, although a strong trend in this direction remained. Reduction of systolic BP was similar in the two groups, whereas atenolol actually was more effective in reducing diastolic BP.

The trial was extended for 1 more year, and now at 3 years, the difference in GFR between the two groups was again apparent and statistically significant, with the mean fall in GFR in the atenolol group being 7% over 3 years vs. 2-3% in the cilazapril group.

Comment: This is an important study, as it measures a clinically relevant outcome variable. The prevalence of diabetics in the groups was not specified, and urinary albumin was apparently not measured. The study is one more piece of evidence of the generally renoprotective effects of ACE inhibitors in hypertensive populations other than diabetics. Certainly a halving of the fall in GFR in treated patients with hypertension would result in many fewer ESRD cases. (John T. Daugirdas, M.D., University of Illinois at Chicago)

ebaa (ebaa2974@yahoo.com)
egypt, assiut - Wednesday, May 19, 2004 at 07:59:32 (PDT)