BLOOD-PRESSURE CONTROL IN NONDIABETIC REN AL-INSUFFICIENCY - DOES IT PREVENT PROGRESSION - DO THE CONVERTING-ENZYME INHIBITORS HAVE A SPECIFIC NEPHROPROTECTIVE EFFECT

Reviewing the literature and the data of the recent French Collaborati ve Study comparing enalapril with conventional antihypertensive drugs in normotensive and hypertensive non diabetic uremic patients the auth ors make the 2 following points: The role of hypertension in the degra dation of renal function is convincingly demonstrated only in a few ex perimental models, and in man only in malignant hypertension and diabe tic nephropathy but not in essential hypertension nor in non-diabetic nephropathy. However, preliminary results suggest that antihypertensiv e treatment may retard the progression of renal disease in normotensiv e patients (DBP < 90 mmHg) with either mircroalbuminuric diabetes and normal renal function or non-diabetic uremic nephropathy. Only the ACE inhibitors have been proved to have a specific renal protective effec t independent of their diurnal blood pressure lowering effect, both in diabetic nephropathy and in non diabetic uremic nephropathy.