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ACE INHIBITORS FOR NONDIABETIC RENAL FAILURE.

Angiotensin-converting-enzyme inhibitors can slow the inevitable decline in renal function in diabetic patients, but can they do the same in nondiabetic renal disease? This multicenter, open, randomized trial in France compared ACE inhibitor therapy with standard beta-blocker therapy in 100 hypertensive, nondiabetic patients with chronic renal failure.

The patients' initial serum creatinine was 200 to 400 micromoles per liter (2.3 to 4.5 mg/dl); 52 received enalapril and 48 received beta-blockers. During three years of follow-up, 35 percent of the beta-blocker group developed end-stage renal failure, versus only 19 percent of the enalapril group. Three patients taking enalapril had to withdraw from the study because of side effects (hyperkalemia in two, cough in one). Patients with glomerular disease showed a significant fall in proteinuria at six months with enalapril as compared with beta-blockers, but this effect was less apparent thereafter. The two groups had similar blood-pressure control.

Comment: This study strongly suggests that ACE inhibition can delay renal deterioration more effectively than beta- blockers in nondiabetic patients with renal failure and hypertension. The mechanism of this effect is unknown, but probably is not related to blood-pressure control. Although we should further investigate the value of ACE inhibitors in different subgroups of patients with renal failure, it is reasonable to consider these drugs in patients with renal disease and hypertension.

— KI Marton

Published in Journal Watch General Medicine October 28, 1994

Citation(s):

Hannedouche T et al. Randomised controlled trial of enalapril and beta blockers in non-diabetic chronic renal failure. BMJ 1994 Oct 1 309 833-837.

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