PLASMA-RENIN ACTIVITY LEVELS INFLUENCE THE EFFECT OF CONVERTING-ENZYME INHIBITORS IN PRESERVING RENAL-FUNCTION IN HYPERTENSION

Objective To study the effect of treatment with cilazapril versus nife dipine on the glomerular filtration rate (GFR), microalbumin excretion rate (mu Alb) and baseline plasma renin activity (PRA) levels in non- diabetic or diabetic essential hypertension. Design and methods Thirty -four moderate essential hypertensives and thirty-two type II diabetic hypertensives with currently normal renal function completed the stud y, receiving treatment with a converting enzyme inhibitor (CEI, 5-10 m g/day cilazapril) or a non-CEI (20-40 mg slow-release nifedipine three times a day) during a 12-month controlled follow-up study. Results Ei ther treatment induced a similar reduction in blood pressure. Patients with PRA > 3 ng/ml per h treated with cilazapril showed a proportiona l increase in GFR, whereas in those treated with a non-CEI there was a decline in GFR after 8 and 12 months. Only diabetic patients treated with cilazapril showed a mu Alb reduction associated with a stable GFR . Conclusion PRA predicts the effect of CEI preserving renal function in essential and diabetic hypertension.