Losartan reduces albuminuria in patients with essential hypertension. An enalapril controlled 3 months study.
BACKGROUND
Elevated urinary albumin excretion is a common feature of essential hypertension which may be reduced by ACE-inhibition through independent reductions of both systemic and intraglomerular pressure. A concurrent inhibition of bradykinin breakdown may be involved.


METHODS
A double-blind, randomized, 12 weeks study of the effects on enalapril 20 mg (n = 46) vs losartan 50 mg daily (n = 47) on blood pressure, albuminuria, fasting blood glucose, and lipids in 57 male and 36 female patients with essential hypertension.


RESULTS
Blood pressure was similarly reduced during both treatments: enalapril 156/102 (15/5) (mean [SD] to 142/92 [14/7]) mmHg, losartan: 159/103 (17/6) to 149/94 (21/9) mmHg, both P < 0.001. Urinary albumin to creatinine ratio was significantly reduced during losartan (from 1.14(x/divided by 2.48) (geometric mean (x/divided by antilog SD) to 0.81 (x/divided by 2.43) mg/mmol, P < 0.01), as well as during enalapril (from 0.95 (x/divided by 2.45) to 0.73 (x/divided by 2.00) mg/mmol, both P < 0.05). The effect on albuminuria was especially evident in patients with microalbuminuria. Fasting blood glucose, total cholesterol, HDL-cholesterol and triglycerides were unchanged during losartan, whereas minor reductions were found in all lipids during enalapril. No difference was observed between the groups.


CONCLUSIONS
Enalapril 20 mg and losartan 50 mg daily reduce blood pressure equally in essential hypertensive patients. No adverse effects were seen on glucose and lipid concentrations. Losartan treatment reduces albuminuria at least as effectively as enalapril, suggesting that glomerular leakage of albumin is profoundly affected by the effects angiotensin II.
Nielsen
S
S
Medical Department M (Endocrinology and Diabetes), Aarhus Kommunehospital, Denmark.
Dollerup
J
J
Nielsen
B
B
Jensen
H A
HA
Mogensen
C E
CE
D000328:Adult; D000419:Albuminuria / Q000188:drug therapy* / Q000209:etiology*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000652:urine*; D007093:Imidazoles / Q000627:therapeutic use*; D019808:Losartan; D008297:Male; D008875:Middle Aged; D013777:Tetrazoles / Q000627:therapeutic use*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D007093:Imidazoles; D013777:Tetrazoles; D004656:Enalapril; D019808:Losartan