ANGIOTENSIN-CONVERTING ENZYME-INHIBITION AND THE COMBINATION OF A BETA-BLOCKER AND A DIURETIC ARE EQUALLY EFFECTIVE IN LOWERING PROTEINURIAIN PATIENTS WITH GLOMERULONEPHRITIS

In this study we compared the antihypertensive and antiproteinuric eff icacies of an angiotensin-converting enzyme inhibitor and of conventio nal treatment consisting of a beta blocker and a diuretic in 13 patien ts with biopsy-proven glomerulonephritis and a proteinuria of more tha n 2 g/24 h. Ten of these 13 patients were normotensive. None had diabe tes mellitus. In a randomized cross-over design with two treatment per iods of 6 weeks, each preceded by a washout period of 4 weeks, patient s were treated with benazepril (20 mg o.d.) and the combination of met oprolol (200 mg o.d.) and chlorthalidone (25 mg o.d.). At the end of t he treatment periods with benazepril or metoprolol/chlorthalidone mean arterial pressure was lowered to a similar degree by 7.4 (mean, 95% c onfidence interval 2.0-12.7) and 9.7 (5.7-13.7) mmHg respectively. Bot h treatment modalities caused similar reductions in proteinuria, being 3.4 g/24 h (mean, 95% confidence interval 2.1-4.8) on benazepril and 3.2 (1.2-5.1) g/24 h on metoprolol/chlorthalidone. Glomerular filtrati on rate and renal plasma flow were slightly less during metoprolol/chl orthalidone treatment. Subgroup analysis of normotensive patients gave similar results. In conclusion, in these patients with glomerular dis ease angiotensin-converting enzyme inhibition was not more effective t han the conventional treatment with the combination of a beta blocker and a diuretic in reducing blood pressure and proteinuria. Both treatm ents reduced proteinuria not only in hypertensive, but also in normote nsive patients.