CAPTOPRIL AND ATENOLOL ARE EQUALLY EFFECTIVE IN RETARDING PROGRESSIONOF DIABETIC NEPHROPATHY - RESULTS OF A 2-YEAR PROSPECTIVE, RANDOMIZEDSTUDY

The progression of diabetic nephropathy can be positively influenced b y maintaining a low blood pressure level. This has been shown in studi es with conventional antihypertensive treatment as well as with ACE in hibitors. Whether the latter group of drugs is more effective remains to be proven and was the aim of our study. In a prospective randomized study we compared the effects of ACE inhibition and beta-blockade on retarding progression of renal function in IDDM patients with an early stage of overt diabetic nephropathy. Twenty-nine patients were studie d for 2 years, 15 were randomized for treatment with captopril and 14 for atenolol. Every 6 weeks blood pressure and urinary albumin and tot al protein excretion were measured. GFR was measured every 6 months as Cr-51-EDTA clearance. Baseline values for blood pressure, renal funct ion and albuminuria were identical in the two groups. The effect of bo th drugs on blood pressure was not significantly different. In the cap topril-treated patients MAP before and after 2 years was 110 +/- 3 (SE M) and 100 +/- 2 mm Hg, respectively and in the atenolol-treated patie nts 105 +/- 2 vs 101 +/- 2 mm Hg. Both drugs reduced alb uminuria and total proteinuria to the same extent. With captopril albuminuria decre ased from 1549 (989-2399) to 851 (537-1380) mg/24 h and proteinuria fr om 2.5 (1.6-3.8) to 1.2 (0.8-1.8) g/24 h. With atenolol albuminuria de creased from 933 (603-1445) to 676 (437-1047) mg/24 h and proteinuria from 1.5 (1.0-2.4) to 0.9 (0.6-1.5) g/24 h. The rate of decline of GFR was similar with both treatments, on captopril -4.9 +/- 2.1 and on at enolol -3.7 +/- 1.6 ml.min(-1).year(-1). No major side effects with ei ther drug were observed. We conclude that, in this 2-year study, capto pril and atenolol are equally effective in retarding progression of di abetic nephropathy.