RANDOMIZED CONTROLLED TRIAL OF ACE-INHIBITORS AND BETA-BLOCKERS WITH AND WITHOUT VASODILATING ACTIVITY IN CHRONIC GLOMERULONEPHRITIS

A prospective double-blind, randomized study was conducted to compare the effects of the beta(1) antagonist, beta(2) agonist celiprolol (200 mg daily) on renal hemodynamics and protein excretion with those of t he beta(1) antagonist atenolol (50 mg daily), the ACE-inhibitor ramipr il (2.5 mg daily),and placebo in 11 patients with proteinuria > 400 mg /24 h due to chronic glomerulonephritis. All 4 substances were given i n a double-blind, randomized manner according to a latin-square design over a period of 4 weeks with a wash-out period of 2 weeks in between , Glomerular filtration rate (GFR) and effective renal plasma flow (ER PF) were measured by inulin and PAH clearance. Proteinuria was assesse d by urine sampling at the end of each treatment period. Mean arterial pressure (MAP) was reduced significantly (p < 0.01) by all 3 drugs co mpared to placebo (108 +/- 9 mmHg placebo, 98 +/- 12 mmHg atenolol, 10 1 +/- 11 mmHg celiprolol, and 98 +/- 8 mmHg ramipril). Celiprolol indu ced a significant increase in ERPF compared to placebo (322 +/- 109 ml /min under placebo versus 391 fl IO ml/min under celiprolol, p < 0.05) . GFR was slightly but insignificantly increased under atenolol and ce liprolol. Filtration fraction (FF) remained unchanged in case of ateno lol and celiprolol treatment and was slightly but not significantly re duced by ramipril. Proteinuria was significantly (p < 0.05) reduced co mpared to placebo by all 3 drugs (1.8 +/- 1.3 g/24 h under placebo, 1. 2 +/- 1.2 g/24 h under atenolol, 1.2 +/- 1.1 g/24 h under celiprolol, and 1.4 +/- 1.4 g/24 h under ramipril). These data demonstrate that ne w beta-blocking agents show favorable effects on proteinuria and renal blood flow in patients with chronic glomerulonephritis and arterial h ypertension. This may be attributed to their vasodilating properties.