Conversion enzyme inhibitors in the antihypertensive treatment of patients with renal insufficiency

Abstract

Changes in serum creatinine concentration and proteinuria over a period of 12 months were analysed retrospectively in hypertensives in renal failure, 39 treated with conversion-enzyme inhibitors and 41 treated with other antihypertensives. The occasionally recorded blood pressures were comparable in the two groups. Median serum creatinine levels in the patients treated with conversion-enzyme inhibitors rose from 2.33 mg/100 ml (range 1.5-5.5) after one month acutely by 0.4 mg/100 ml and then remained essentially constant. In nine patients the level was higher by greater than or equal to 0.5 mg/100 ml after 12 months than at the beginning of treatment. Proteinuria did not show any identifiable changes. On the other hand, in those patients treated with other antihypertensives, median serum creatinine concentration rose gradually over 12 months from 2.4 mg/100 ml (range 1.5-6.0) to 3.45 mg/100 ml (1.5-12.9). In 18 patients the serum creatinine level rose by less than or equal to 0.5 mg/100 ml. Five patients developed side effects to conversion-enzyme inhibitors, but none required discontinuation of treatment. It is concluded that the use of conversion-enzyme inhibitors in patients with renal failure is effective and largely safe. It apparently causes less of a rise in serum creatinine than other antihypertensives.