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Renal protective effect of enalapril in diabetic nephropathy
S Björck1, H Mulec, S A Johnsen
1Department of Nephrology, Sahlgrenska Hospital, University of Göteborg, Sweden.
Objective:
To determine whether inhibition of angiotensin converting enzyme can reduce the rate of decline in kidney function more than reducing blood pressure with other antihypertensive treatment.
Design:
Prospective, open randomised study lasting a mean of 2.2 years in patients with diabetic nephropathy.
Setting:
Three outpatient nephrology clinics.
Patients:
40 patients with insulin dependent diabetes and diabetic nephropathy with reduced renal function.
Intervention:
Antihypertensive treatment with enalapril or metoprolol, usually combined with frusemide.
Main Outcome Measure:
Rate of decline in glomerular filtration rate measured as chromium-51 edetic acid clearance.
Results:
Glomerular filtration rate declined a mean of 2.0 (SD 3.2) ml/min/year in the group given enalapril and 5.6 (5.9) ml/min/year in the control group. The mean arterial blood pressure during the study was 102 (5) mm Hg in the patients given enalapril and 103 (5) mm Hg in the patients given metoprolol. Urinary albumin excretion during treatment with enalapril was 60% lower than during treatment with metoprolol.
Conclusions:
Enalapril has an antiproteinuric effect independent of the effect on systemic blood pressure. Treatment with enalapril can reduce the rate of decline in kidney function in patients with diabetic nephropathy more than equally effective antihypertensive treatment with metoprolol. This points to a specific renal protective effect of angiotensin converting enzyme inhibitors in diabetic nephropathy.
Insights
Angiotensin converting enzyme inhibitors like enalapril slow kidney function decline in diabetic nephropathy more than other blood pressure treatments. Enalapril also reduces protein in urine, showing a specific kidney protective effect.
Area of Science:
- Nephrology
- Diabetology
- Cardiovascular Medicine
Background:
- Diabetic nephropathy is a leading cause of chronic kidney disease.
- Controlling blood pressure is crucial in managing diabetic nephropathy.
- The specific renal protective effects of different antihypertensive classes require further investigation.
Purpose of the Study:
- To compare the efficacy of angiotensin converting enzyme (ACE) inhibition versus other antihypertensive treatments in slowing kidney function decline.
- To determine if ACE inhibition offers renal protection beyond its blood pressure-lowering effects in diabetic nephropathy.
Main Methods:
- Prospective, open-label randomized study over 2.2 years.
- Involved 40 patients with insulin-dependent diabetes and diabetic nephropathy.
- Compared enalapril (ACE inhibitor) with metoprolol (beta-blocker), often with frusemide, measuring glomerular filtration rate (GFR) decline.
Main Results:
- GFR declined significantly slower with enalapril (2.0 ml/min/year) compared to metoprolol (5.6 ml/min/year).
- Mean arterial blood pressure was similar between groups (102 vs 103 mm Hg).
- Urinary albumin excretion was 60% lower in the enalapril group.
Conclusions:
- Enalapril demonstrates an antiproteinuric effect independent of blood pressure reduction.
- ACE inhibitors, specifically enalapril, provide superior renal protection in diabetic nephropathy compared to equally effective antihypertensive agents like metoprolol.
- These findings suggest a specific renal protective mechanism of ACE inhibitors in diabetic nephropathy.