Long-term enalapril therapy in patients with chronic renal failure on a low-protein diet. A prospective randomized comparison with metoprolol.
The effect of enalapril (5-10 mg/day) on the progression of chronic renal failure (CRF) was compared with that of metoprolol (40-120 mg/day) in 28 patients for 24 months in a prospective study. Throughout the study, there was no significant difference between the 2 groups in protein intake and urinary sodium excretion. But there was a significant difference between the 2 groups in diastolic and mean arterial blood pressure at 6 months. In the serum creatinine level, there was a significant difference between the 2 groups at 6, 12, 18, and 24 months. In creatinine clearance, there was a significant difference between the 2 groups at 24 months. In addition, the progression of CRF was significantly faster in the metoprolol group than the enalapril group as estimated from the slope of creatinine clearance (p < 0.05) and the slope of glomerular filtration rate (p < 0.0005). In urinary protein excretion, there was a significant difference between the 2 groups at 6 and 18 months (p < 0.05). These findings indicate that enalapril has a suppressive effect on the progression of CRF and also has an antiproteinuric effect by a mechanism independent of its antihypertensive effect.
Shiigai
T
T
Department of Internal Medicine, Toride Kyodo General Hospital, Ibaraki, Japan.
Hattori
K
K
Iwamoto
H
H
Owada
A
A
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D008076:Cholesterol, HDL / Q000097:blood; D003404:Creatinine / Q000378:metabolism; D018753:Diet, Protein-Restricted; D004044:Dietary Proteins / Q000008:administration & dosage; D004656:Enalapril / Q000008:administration & dosage*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy / Q000188:drug therapy*; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy; D012964:Sodium / Q000652:urine; D014280:Triglycerides / Q000097:blood
D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D004044:Dietary Proteins; D014280:Triglycerides; D004656:Enalapril; D012964:Sodium; D003404:Creatinine; D008790:Metoprolol