There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
Hypertension, which occurs commonly and early in autosomal dominant polycystic kidney
disease (ADPKD), affects both renal and patient outcome. However, there is no consensus
about the type of antihypertensive therapy that is most appropriate for patients with
ADPKD. This historical prospective, nonrandomized study was designed to investigate
the effect on renal function of diuretics versus angiotensin-converting enzyme (ACE)
inhibitors in hypertensive patients with ADPKD who entered the study with comparable
renal function. Among hypertensive ADPKD patients followed in our center, patients
taking diuretics without any ACE inhibitors were included in the diuretic group (n
= 14, male/female ratio 5/9, mean age 47 years), whereas patients taking ACE inhibitors
but no diuretics were included in the ACE inhibitor (ACEI) group (n = 19, male/female
ratio 11/8, mean age 41 years). For comparable blood pressure control, 21% of the
ACEI group and 64% of the diuretic group (p < 0.05) needed additional antihypertensive
medications. After an average follow-up period of 5.2 years, the creatinine clearance
decreased significantly in the diuretic group (74 vs. 46 ml/min/1.73 m<sup>2</sup>,
p < 0.0001) and in the ACEI group (83 vs. 71 ml/min/1.73 m<sup>2</sup>, p = 0.0005).
The decrement in creatinine clearance was significantly larger in the diuretic group
than the ACEI group (p < 0.05). The annual decrease in creatinine clearance was 5.3 ml/min/1.73 m<sup>2</sup>
in the diuretic group and 2.7 ml/min/1.73 m<sup>2</sup> in the ACEI group (p < 0.05).
A significant increase in urinary protein excretion occurred in the diuretic but not
in the ACEI group. Hypertensive ADPKD patients treated with diuretics had a faster
loss of renal function as compared with patients treated with ACE inhibitors, despite
similar blood pressure control. This result will need to be further examined in a
randomized study.