EFFECT OF QUINAPRIL ON THE ALBUMIN EXCRETION RATE IN PATIENTS WITH MILD-TO-MODERATE ESSENTIAL-HYPERTENSION

In patients with essential hypertension, correlations have been report ed between the albumin excretion rate (AER) and ambulatory and casual blood pressure. Microalbuminuria has been indicated as a possible pred ictor of cardiovascular morbidity and mortality, The objective of this trial was to evaluate the effect of quinapril, an angiotensin convert ing enzyme inhibitor with high tissue affinity for the enzyme, on the AER in patients with mild to moderate essential hypertension and no ev idence of diabetes mellitus. In this 12 week, 24 center study, quinapr il was administered to 213 patients and titrated to 10, 20, or 40 mg/d ay alone or 20 mg/day plus 12.5 mg/day hydrochlorothiazide. Overall, b lood pressure was reduced from 155.2 +/- 18.1/101.8 +/- 6.7 mm Hg (mea n +/- SD) to 144.4 +/- 17.8/92.3 +/- 8.9 mm Hg (P =.0001) and AER decr eased from 20.6 +/- 24.3 mg/24 h to 14.5 +/- 15.4 mg/24 h (P =.0001). The BP reductions were significant in all age groups. AER at endpoint was reduced 37.5% in elderly, 29.8% in middle-aged, and 11.8% in young patients from 32.5 +/- 45.0 mg/ 24 h, 19.1 +/- 20.9 mg/24 h, and 16.1 +/- 16.9 mg/24 h, respectively. The AER decreased in 60% of patients who had normal AER (0 to 30 mg/24 h), in 79% of those who had microalb uminuria (30 to 300 mg/24 h), and in 90% of those who had proteinuria (>300 mg/24 h) at baseline. Baseline log-AER correlated with SBP (P =. 0126, R = 0.19) and creatinine clearance (P =.026, R = 0.17), while en dpoint log-AER correlated with SBP (P = .0015, R = 0.25) and DBP (P =. 03, R = 0.17). In summary, we showed, in a large group of patients wit h mild to moderate essential hypertension and no evidence of diabetes mellitus, that quinapril not only lowers BP significantly but also red uces microalbuminuria.