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Efficacy and Renal Effects of Enalapril Therapy for Hypertensive Patients With Chronic Renal Insufficiency
Paul A. Abraham, MD;
John A. Opsahl, MD;
Charles E. Halstenson, PharmD;
William F. Keane, MD
Arch Intern Med. 1988;148(11):2358-2362.
Abstract
• The antihypertensive efficacy and renal effects of enalapril maleate therapy were evaluated in 13 hypertensive patients with chronic renal failure. Enalapril was administered as follows: alone; added to furosemide, clonidine hydrochloride, or atenolol; or in combination with any of the aforementioned drugs. Three patients did not complete the study; uncontrolled hypertension was the cause in two of these patients. In the remaining ten patients, short-term (mean±SD, 63±9 days) enalapril maleate therapy decreased the patient's seated blood pressure from 161/98±19/8 to 130/80±13/7 mm Hg. Furosemide was administered to eight patients; the dose of concomitant sympatholytic therapy was decreased in five of five patients. Serum potassium concentration increased from 4.1±0.3 to 4.5±0.3 mmol/L. Levels of urinary total protein excretion decreased from 2.23±2.05 to 1.08±1.45 g/d. Renal function (creatinine clearance, 0.58±0.21 mL/s) did not change from baseline. During long-term therapy, the rate of progression of renal insufficiency seemed to slacken in three of four patients with diabetic nephropathy. Thus enalapril can reduce blood pressure and proteinuria in hypertensive patients with chronic renal insufficiency. The possibility that enalapril can slow the progression of diabetic nephropathy remains to be confirmed by future studies.
(Arch Intern Med 1988;148:2358-2362)
Author Affiliations
From the Division of Nephrology, Department of Medicine, Hennepin County (Minnesota) Medical Center (Drs Abraham, Opsahl, Halstenson, and Keane), and the School of Medicine (Drs Abraham, Opsahl, and Keane) and College of Pharmacy (Drs Abraham, Opsahl, Halstenson, and Keane), University of Minnesota, Minneapolis.
Footnotes
Accepted for publication May 2, 1988.
Reprint requests to Regional Kidney Disease Program, 701 Park Ave, Minneapolis, MN 55415 (Dr Abraham).
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