Effects of Atenolol and Enalapril on Kidney Function in Hypertensive Diabetic Patients

Reduction of Renal Function by Angiotensin-Converting Enzyme Inhibitors: Effect of Verapamil

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There is a large corpus of papers claiming a beneficial effect of ACEI in renal function in hypertensive patients, particularly in dia betic hypertensives [ 1], A recent meta regres sion analysis of 100 clinical trials in patients with IDDM and NIDDM suggests that ACEI exhibits a specific renoprotective ef fect independent of the antihypertensive ef fect [2], There are studies giving evidence that ACEI (lisinopril) and non-dihydropy ridine calcium channel blockers are superior in lowering blood pressure, albuminuria, and reducing the rate of decline of GFR than the combination of diuretics and beta-block ers [3], Enalapril is more effective than ate nolol in preserving GFR in spite of a similar reduction in blood pressure and urinary al bumin excretion [4], On the other hand, a worsening of renal function in some patients treated by ACEI has recently been communi cated [5], particularly in patients with some degree of renal deterioration. Until now this side effect has been overcome by discontin uation of ACEI [5], We present data con cerning the influence of ACEI on serum cre atinine in 11 patients aged 68.45 ± 1.46 years (range 23-82), 5 females and 6 males with mean serum creatinine before ACEI of 110.5 ±41.5 pmol I-1.

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Design and Statistical Aspects of the African American Study of Kidney Disease and Hypertension (AASK)

“…These hemodynamic effects are distinct from each intervention's hypothesized longterm effects on the progression of kidney disease. Past studies have suggested that, initially, ACEI may reduce GFR by 2 to 6% (32-34), DHPCCB may increase GFR by 2 to 4% (35,36), BB may reduce GFR by 1 to 2% (35,37), and the low BP goal may reduce GFR by 2% (38). Some research suggests that the initial hemodynamic effects persist as long as the patients remain on their respective interventions and that, at least for ACEI, the effect is reversible on termination of the therapy (39,40).…”

New Insights into the Combined Burden of Type 2 Diabetes and Hypertension

“…Therefore, beta-blockers play an important role in the management of hypertension in diabetic patients. Beta-blockers have been shown to produce similar reductions in proteinuria when compared to ACE inhibitors in three trials in diabetic hypertensive patients [48][49][50]. There are concerns about the use of beta-blockers in diabetics, given the fact that they have been shown to worsen glycemic control in diabetic patients with hypertension [19,51], they may increase triglyceride and lowdensity lipoprotein cholesterol levels and lower high-density lipoprotein cholesterol levels, and they may adversely affect the awareness of and recovery from hypoglycemia.…”