The aim of our study was to evaluate whether inhibition of ACE (lisinopril 10–20 mg/day) can reduce the rate of decline in kidney function more than reducing blood pressure with conventional antihypertensive treatment (atenolol 50–100 mg/day), usually in combination with a diuretic. We performed a prospective, randomized, parallel study for 42 months, double blind for the first 12 months and single blind thereafter. Forty-three (21 lisinopril and 22 atenolol) hypertensive NIDDM patients with diabetic nephropathy were enrolled. Data from 36 patients (17 lisinopril and 19 atenolol, 60 ± 7 years of age, 27 men) who completed at least 12 months of the study period are presented. At baseline, the two groups were comparable: glomerular filtration rate (51Cr-EDTA plasma clearance) was 75 ± 6 and 74 ± 8 ml · min−1 · 1.73 m−2, mean 24-h ambulatory blood pressure (A&D TM2420) was 110 ± 3 and 114 ± 2 mmHg, and 24-h urinary albumin excretion rate was 961 (range 331–5,727) and 1,578 (476–5,806) mg/24 h in the lisinopril and atenolol groups, respectively. The mean follow-up time was similar, 37 and 35 months in the lisinopril and atenolol groups, respectively. Mean ambulatory blood pressure was equally reduced in the two groups, 12 ± 2 and 10 ± 2 mmHg in the lisinopril and atenolol groups, respectively. Glomerular filtration rate declined in a biphasic manner with a faster initial (0 to 6 months) change of 1.25 ± 0.49 and 0.81 ± 0.29 ml · min−1 · month−1 followed by a slower sustained decline (6 to 42 months) of 0.59 ± 0.10 and 0.54 ± 0.13 ml · min−1 · month−1 in the lisinopril and atenolol groups, respectively. No significant differences were observed in either initial or sustained decline in glomerular filtration rate between the two groups. Urinary albumin excretion was reduced (% reduction of baseline) more in the lisinopril than in the atenolol group, at 55 (95% CI 29–72) and 15% (−13 to 34), respectively (P = 0.01). In conclusion, the relentless decline in kidney function characteristically found in hypertensive NIDDM patients with diabetic nephropathy can be reduced equally effectively by two antihypertensive treatments, the β-blocker atenolol and the ACE inhibitor lisinopril.
- Received August 28, 1996.
- Revision received March 4, 1997.
- Accepted March 4, 1997.
- Copyright © 1997 by the American Diabetes Association