Nielsen FS, Rossing P, Gall MA, Scott P, Smidt UM, Parving HH
Long term impact of lisinopril and atenolol on kidney function
in NIDDM patients with diabetic nephropathy
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1363 1996
The relative efficacy of ACE inhibitors vs. other antihypertensive
drugs in NIDDM patients with nephropathy is controversial. In this
prospective, randomized, parallel study, patients were treated with
either lisinopril 10-20 mg/d (n=21) or atenolol 50-100 mg/d (n=22).
The two groups had similar GFR, BP, and albumin excretion rates at
baseline. Mean follow-up time was 36 mo. Mean BP was equally
reduced in the 2 groups. GFR declined in a biphasic manner with a
faster initial (0-6 mo) decline in both groups. No significant
differences were observed in either initial or sustained decline in
GFR between the groups. However, albuminuria was reduced more in
the lisinopril group (55%) as compared to the atenolol group (15%),
p = 0.01. The authors conclude that linisopril and atenolol have
equivalent effects on rate of progression of nephropathy in NIDDM.
Comment: These authors previously published that lisinopril and
atenolol had equivalent effects on GFR after one year (Diabetes
1994; 42: 1108-13); this followup data suggests that ACE inhibitors
do not confer a selective long-term benefit either. Thus, there
are yet no data that support the hypothesis that ACE inhibitors are
more renoprotective than other antihypertensives in this
population.
(David J. Leehey, M.D., Loyola University at Chicago)
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Am Soc Nephrol
H: Pathophysiology :
Kidney in hypertension
H: Drug therapy :
Beta blockers