Comparison of captopril and enalapril in the treatment of hypertension in patients with non-insulin dependent diabetes mellitus and nephropathy

Abstract

Eighteen patients with non-insulin dependent diabetes mellitus (NIDDM), hypertension and nephropathy were randomized to receive captopril or enalapril for 6 months. Two patients with serum creatinine of greater than 400 mumol/l had to be excluded from the study because of rapidly deteriorating renal function after starting treatment. Of the remaining patients, 7 received captopril and 9 received enalapril. Blood pressure control was achieved in about 50% of patients with either drug alone. Serum creatinine and creatinine clearance were unchanged in both groups but there was a greater tendency for the former to increase in patients with higher pretreatment values. Proteinuria was reduced at 1 month only in the enalapril group which also showed a significant elevation of serum potassium after treatment. Captopril and enalapril have only a modest antihypertensive action in patients with NIDDM and nephropathy. Their use in patients with renal insufficiency must be balanced against the risk of further aggravating the deterioration of renal function.

Serum uric acid level and renal function tests in hypertensive patients treated by captopril

“…This result is in agreement with the result of other studies done by 17,18 who found that there was normal level of serum creatinine in patients treated by captopril in comparison to control group and they concluded that captopril is a safe drug for the treatment of patients with essential hypertension. Furthermore, this result is in agreement with the result of the study done by Cheng et al, 19 who studied the effect of captopril in 18 hypertensive patients with diabetic nephropathy for 6 months and they found that there were no changes in Crcl but there was a greater tendency to increase serum creatinine in patients with higher pretreatment value so the use of captopril in patients with renal impairment must be balanced against the risk of aggravating the deterioration of renal functions. However other studies 20,21 found that captopril therapy didn't cause any significant change in Crcl and preserves renal functions in hypertensive patients with type II diabetes mellitus by inhibition of ACE which leads to vasodilatation and increase renal blood flow.…”