Randomised controlled trial of enalapril and beta blockers in non-diabetic chronic renal failure.
OBJECTIVE
To compare the ability of angiotensin converting enzyme inhibitors and beta blockers to slow the development of end stage renal failure in non-diabetic patients with chronic renal failure.


METHODS
Open randomised multicentre trial with three year follow up.


METHODS
Outpatient departments of six French hospitals.


METHODS
100 hypertensive patients with chronic renal failure (initial serum creatinine 200-400 mumol/l. 52 randomised to enalapril and 48 to beta blockers (conventional treatment).


METHODS
Enalapril or beta blocker was combined with frusemide and, if necessary, a calcium blocker or centrally acting drug in patients whose diastolic pressure remained above 90 mm Hg.


RESULTS
17 patients receiving conventional treatment and 10 receiving enalapril developed end stage renal failure. The cumulative renal survival rate was significantly better in the enalapril group than in the conventional group (P < 0.05). The slope of the reciprocal serum creatinine concentration was steeper in the conventionally treated patients (-6.89 x 10(-5)l/mumol/month) than in the enalapril group (-4.17 x 10(-5)l/mumol/month; P < 0.05). No difference in blood pressure was found between groups.


CONCLUSIONS
In hypertensive patients with chronic renal failure enalapril slows progression towards end stage renal failure compared with beta blockers. This effect was probably not mediated through controlling blood pressure.
Hannedouche
T
T
Department of Nephrology, Hôpital Necker, Paris, France.
Landais
P
P
Goldfarb
B
B
el Esper
N
N
Fournier
A
A
Godin
M
M
Durand
D
D
Chanard
J
J
Mignon
F
F
Suo
J M
JM
D000070:Acebutolol / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001262:Atenolol / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure; D001835:Body Weight; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011507:Proteinuria / Q000209:etiology
D001262:Atenolol; D000070:Acebutolol; D004656:Enalapril; D011188:Potassium