Nephrology Dialysis Transplantation, Vol 12, Issue 11 2289-2294, Copyright © 1997 by Oxford University Press
M Aurell, C Bengtsson and S Bjorck
Background: Hypertension is a significant cause of
end-stage renal failure and effective treatment of hypertensive will reduce
the progression rate of chronic renal failure in various kidney disorders.
Different classes of drugs may be more effective than others in this
respect. In this study we compared the effects on the glomerular filtration
rate (GFR) of the ACE-inhibitor enalapril and the betablocker metoprolol in
patients with mild and moderate primary hypertension during 6 years.
Methods: Patients with GFR in the normal range
(⩾80 ml/min/1.73 m2 BSA) were included after
a placebo treatment period of 4-8 weeks if diastolic blood pressure was
100-120 mmHg. Target blood pressure was set to <90 mm Hg diastolic.
One hundred and thirty patients were randomized in an open parallel study
to receive either enalapril or metoprolol. No placebo groups was included.
GFR was measured using the 51Cr-EDTA clearance
method and 81 patients completed the study. Results:
At inclusion, there was no significant differences regarding GFR or blood
pressure between the groups. The blood pressure treatment goal was reached
in all patients and was maintained during the whole observation period. A
small but significant fall in GFR by 4 ml/min/1.73
m2 BSA was noted in both groups after the first year
of treatment but thereafter GFR decreased by only 1 ml/min/year/1.73
m2 BSA in both groups. Body weight, serum uric acid
and triglycerides increased slightly with metoprolol treatment but no other
differences between the two treatments were noted.
Conclusions: With the blood pressure maintained at the
same level using either enalapril or metoprolol during a 6-year study
period, GFR decreased to the same extent in the two groups both during the
first year and thereafter. The overall magnitude of the GFR decline
approached that of the normal age-related decrease of kidney function, i.e.
GFR decreased only about 1 ml/min/year. Thus, treatment with an
ACE-inhibitor , enalapril, and a beta-blocker, metoprolol, protected the
kidney function to the same extent in this 6 year long study in mild and
moderate primary hypertension. Key words:
ACE-inhibitors; antihypertensive treatment; betablockers; glomerular
filtration rate; hypertension
ORIGINAL ARTICLES
Enalapril versus metoprolol in primary hypertension - effects on the glomerular filtration rate
Departments of Nephrology and General Medicine, University of Gotbeborg, Goteborg, Sweden; Corresponding author at: Department of Nephrology, Sahlgrenska University Hospital, S-413 45 Goteborg, Sweden
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