van Essen GG, Apperloo AJ, Sluiter WJ, de Zeeuw D, de Jong PE
Is ACE inhibition superior to conventional antihypertensive
therapy in retarding progression in non-diabetic renal disease?
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1401 1996
The use of ACE inhibitors has been advocated to retard loss of
renal function in CRF. In a prospective double blind trial, the
effect of the ACE inhibitor enalapril was compared to the beta-blocker
atenolol on the decline of GFR (125-I-iothalamate) in 89
patients with non-diabetic nephropathies (mean baseline GFR 53
ml/min, mean protein excretion approx. 1.5 g/d). The goal was a 10
mmHg decline in DBP. Mean follow up was 3.6 y. No significant
difference in BP response or GFR slope was found between the two
groups. The chance of missing a selective benefit for enalapril
(Type II error) was estimated to be < 1.25%. The authors conclude
that ACE inhibitors are not necessarily more beneficial than beta-blockers
in non-diabetic renal diseases.
Comment: This is an important study and points to the paramount
importance of BP control in the management of patients with CRF.
Whether ACE inhibitors are more renoprotective than other
antihypertensives in this population is as of yet unproven.
(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