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      Effects of Angiotensin-Converting Enzyme Inhibition versus Conventional Antihypertensive Therapy on the Glomerular Filtration Rate

      Cardiology

      S. Karger AG

      Essential hypertension, ACE inhibition, Antihypertensive treatment

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          Abstract

          Antihypertensive treatment has been shown to slow down the decline in glomerular filtration rate (GFR) with time. This has been most extensively studied in patients with diabetic nephropathy and, to some extent, with other forms of renal disease. Angiotensin-converting enzyme (ACE) inhibition has been shown to be more effective in this regard than conventional antihypertensive therapy. This important aspect of antihypertensive treatment has not been studied previously in patients with essential hypertension. Preliminary results regarding the effects of two different antihypertensive therapies on the loss of GFR with time, determined with <sup>51</sup>Cr-EDTA clearance after 6, 12, and 24 months of treatment, are presented here. The GFR was assessed in a prospective, randomized, double-blind trial in 257 patients with essential hypertension. All had a normal renal function, and none had diabetes mellitus or glucosuria. The two therapeutic modalities were the ACE inhibitor cilazapril and the β-adrenoceptor blocking agent atenolol. Both therapies were equally effective in lowering the systolic blood pressure. However, atenolol was slightly but significantly more effective in lowering the diastolic blood pressure after 6, 12, and 24 months. The decline in GFR with time was significantly smaller with cilazapril than with atenolol. After 6 months, the reduction in GFR was 1.0 (cilazapril) vs. 4.0 (atenolol) ml/min × 1.73 m<sup>2</sup> (p < 0.01). After 12 months the corresponding changes were 2.0 vs. 4.5 ml/min × 1.73 m<sup>2</sup> (p < 0.05) and after 24 months 3.0 vs. 4.0 ml/min × 1.73 m<sup>2</sup> (n.s.). These results indicate that an ACE-inhibitor-based antihypertensive therapy with cilazapril in patients with essential hypertension prevents the decline in GFR with time better than a β-blocker-based regimen after 6 and 12 months of treatment. Thus, the advantage of ACE inhibition in this regard, which has previously been shown in patients with diabetic nephropathy, holds true also in essential hypertension.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-6154-9
          978-3-318-01937-7
          0008-6312
          1421-9751
          1995
          1995
          19 November 2008
          : 86
          : Suppl 1
          : 30-33
          Affiliations
          Division of Clinical Hypertension Research, Department of Geriatrics, University of Uppsala, Sweden
          Article
          176943 Cardiology 1995;86:30–33
          10.1159/000176943
          7614504
          © 1995 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 4
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