ACE Inhibition Preserves Renal Function Better thanbT-blockade in the Treatment of Essential Hypertension

Abstract

Antihypertensive treatment can slow down the decline in glomerular filtration rate (GFR) with time. In patients with diabetic nephropathy, angiotensin converting enzyme (ACE) inhibition has been shown to be more effective in this regard than conventional antihypertensive therapy. Whether this applies to the much larger population of patients with essential hypertension is not yet known. In the present study, the effects of two different antihypertensive therapies on the loss of GFR with time, determined with Cr51-EDTA clearance after 6, 12 and 24 months of treatment, were assessed in a prospective, randomised, double-blind trial in 257 patients with essential hypertension. All had normal renal function and none had diabetes mellitus or glucosuria. Proteinuria (dipstick positive or trace) was detected in 7 patients initially. The two therapeutic modalities were the ACE inhibitor cilazapril and the beta-adrenoceptor blocking agent atenolol. Both therapies were equally effective in lowering systolic blood pressure (e.g. from 168 mmHg to 152 mmHg with cilazapril and from 170 mmHg to 155 mmHg with atenolol after 6 months, p < 0.001 for both). However, atenolol was slightly but significantly more effective in lowering the diastolic blood pressure at 6, 12 and 24 months. The decline in GFR with time was significantly smaller with cilazapril than with atenolol. After 6 months the reduction in GFR was 1.0 vs. 4.0 ml/min x 1.73 m2, p = 0.008 (cilazapril vs. atenolol) and after 12 months the corresponding changes were 2.0 vs. 4.5 ml/min x 1.73 m2, p = 0.04 and after 24 months 3.0 vs. 4.0 ml/min x 1.73 m2, respectively (n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)

Do β-blockers combined with RAS inhibitors make sense after all to protect against renal injury?

“…In small controlled human studies of nondiabetic patients with CKD, ACE inhibitors at the given dose were consistently superior to alternative treatment including -blockers [47][48][49] with respect to reducing proteinuria, GFR loss, or renal failure. In the AASK trial, ramipril was better with respect to a composite end point, but the primary analysis of the GFR slope did not establish a definite difference among the three agents (ramipril, long-acting metoprolol, and amlodipine) [40].…”

Pharmacological safety during pregnancy: the principles of teratogenesis and teratogenicity of drugs

“…Два класса часто используемых антигипертензивных препаратов -ингибиторы ангиотензинпревращающего фермента (АПФ) и блокаторы рецепторов ангиотензина II (АТ II), нарушая функцию РААC, могут оказывать негатив-ное влияние на внутриутробное развитие ребенка [62]. В сравнении с другими антигипертензивными препара-тами ингибиторы АПФ в большей степени вляют на ско-рость клубочковой фильтрации [63]. По опубликованным данным, в результате применения ингибиторов АПФ в любом триместре беременности могут развиться раз-нообразные нарушения: маловодие, задержка внутри-утробного развития, преждевременные роды, почечная недостаточность, пороки развития костей, контрактуры конечностей, открытый артериальный проток, гипопла-зия легких, респираторный дистресс-синдром [64,65].…”

Effects of Angiotensin-Converting Enzyme Inhibition versus Conventional Antihypertensive Therapy on the Glomerular Filtration Rate

“…Determinations of 5lCr-EDTA clearance [11] were made at 0, 6, 12, and 24 months in 257 patients with essential hypertension. The complete and definitive results will be published else where [12],…”