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Randomised controlled trial of enalapril and beta blockers in non-diabetic chronic renal failure
T Hannedouche1, P Landais, B Goldfarb
1Department of Nephrology, Hôpital Necker, Paris, France.
Insights
Angiotensin converting enzyme inhibitors like enalapril slow chronic renal failure progression more effectively than beta blockers in hypertensive patients. This benefit in renal survival was observed independently of blood pressure control.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Pharmacology
Background:
- Chronic renal failure (CRF) is a progressive condition leading to end-stage renal disease (ESRD).
- Hypertension is a common comorbidity and a risk factor for CRF progression.
- Angiotensin converting enzyme (ACE) inhibitors and beta blockers are frequently used antihypertensive agents.
Purpose of the Study:
- To compare the efficacy of ACE inhibitors (enalapril) versus beta blockers in slowing the progression of CRF in non-diabetic patients.
- To evaluate the impact of these drug classes on the development of ESRD.
Main Methods:
- An open-label, randomized, multicenter trial with a three-year follow-up.
- 100 hypertensive patients with CRF (serum creatinine 200-400 mumol/l) were randomized to receive either enalapril or beta blockers.
- Concomitant medications included frusemide and, if needed, calcium channel blockers or centrally acting agents to manage blood pressure above 90 mm Hg diastolic.
Main Results:
- Fewer patients in the enalapril group (10/52) progressed to ESRD compared to the conventional beta-blocker group (17/48).
- The cumulative renal survival rate was significantly better for enalapril (P < 0.05).
- The rate of decline in renal function, indicated by the slope of reciprocal serum creatinine, was significantly slower with enalapril (-4.17 x 10(-5) l/mumol/month) compared to beta blockers (-6.89 x 10(-5) l/mumol/month; P < 0.05).
- No significant difference in blood pressure control was observed between the two groups.
Conclusions:
- Enalapril demonstrates a significant benefit in slowing the progression of chronic renal failure towards end-stage renal disease in hypertensive patients compared to traditional beta-blocker therapy.
- The renoprotective effect of enalapril in this context appears to be independent of its blood pressure-lowering effects.
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.
Design:
Open randomised multicentre trial with three year follow up.
Setting:
Outpatient departments of six French hospitals.
Patients:
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).
Interventions:
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.
Conclusion:
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.