Related Experiment Videos
Renal protective effect of strict blood pressure control with enalapril therapy
Insights
Strict blood pressure control using enalapril or enalapril-hydrochlorothiazide therapy preserved renal function in patients with essential hypertension. Renal plasma flow increased, while filtration rate and protein excretion remained stable.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Essential hypertension poses risks to renal function.
- The impact of strict blood pressure control on kidney disease progression is not fully understood.
Purpose of the Study:
- To evaluate the effect of strict blood pressure control on renal disease progression in patients with essential hypertension.
- To assess changes in renal function parameters under specific antihypertensive therapy.
Main Methods:
- Prospective follow-up of 23 essential hypertension patients over three years.
- Blood pressure management using enalapril or enalapril-hydrochlorothiazide.
- Yearly assessment of glomerular filtration rate (creatinine/inulin clearance) and effective renal plasma flow.
Main Results:
- No change in glomerular filtration rate observed.
- Sustained 17% increase in effective renal plasma flow.
- In patients with moderate renal impairment, significant increases in inulin clearance and effective renal plasma flow were noted, sustained at three years.
Conclusions:
- Long-term blood pressure control with enalapril or enalapril-hydrochlorothiazide is associated with renal function preservation.
- Angiotensin-converting enzyme inhibitor therapy may improve or preserve kidney function in hypertensive patients.
- Filtration fraction and urinary protein excretion remained unchanged, indicating no adverse effects on these parameters.
Abstract:
The effect of strict blood pressure control on progression of renal disease in patients with essential hypertension has not been well defined. We have followed prospectively for three years 23 patients with essential hypertension. Blood pressure was well controlled on either enalapril or enalapril-hydrochlorothiazide therapy. Yearly assessment of renal function revealed no change in glomerular filtration rate as assessed by creatinine or inulin clearance, and a sustained 17% increase in effective renal plasma flow. In patients with moderately impaired renal function (inulin clearance less than or equal to 1.33 mL/s [80 mL/min]), there was a first-year 50% increase in inulin clearance, and a 33% increase in inulin clearance at year three. In these patients, there was a 39% first-year increase in effective renal plasma flow, which was sustained at year three. Filtration fraction and urinary protein excretion were unchanged. These results suggest that long-term blood pressure control with the angiotensin-converting enzyme inhibitor enalapril or enalapril-hydrochlorothiazide is associated with preservation and/or improvement in renal function.