EFFECTS OF THE ANGIOTENSIN-II ANTAGONIST LOSARTAN IN HYPERTENSIVE PATIENTS WITH RENAL-DISEASE

Objective: To study the effects of the angiotensin II antagonist losar tan in hypertensive patients with renal disease. Design: A single-blin d longitudinal study was performed, lasting 4 months. Patients were tr eated once a day with placebo, 50 mg losartan, 100 mg losartan and pla cebo, each for 1 month, in sequence. Measurements were take at the end of each treatment period. Patients: The study subjects comprised 13 p atients with biopsy-proven renal disease, a diastolic blood pressure o f >90 mmHg, creatinine clearance of >60 ml/min and stable proteinuria of >2.0 g/day. Results: Mean arterial pressure, measured 4h after the dose, fell from 113.8 +/- 2.1 mmHg (placebo) to 99.2 +/- 2.4 mmHg (50- mg dose) and 96.5 +/- 2.4 mmHg (100-mg dose). This blood pressure lowe ring effect was sustained for 24 h [116.3 +/- 2.3 mmHg (placebo) versu s 105.5 +/- 1.8 mmHg (50-mg dose) and 103.3 +/- 1.9 mmHg (100-mg dose) ]. The glomerular filtration rate remained stable, while the effective renal plasma flow increased by 12.5 +/- 2.9% (100-mg dose). The syste mic and renal hemodynamic effects were similar at the 50- and 100-mg d oses. Urinary excretion of total protein, albumin and immunoglobulin G decreased dose-dependently by a maximum of +/-50% (100-mg dose). With the high dose, serum uric acid fell from 0.43 +/- 0.02 mmol/l to 0.39 +/- 0.02 mmol/l, and potassium increased from 4.2 +/- 0.1 to 4.6 +/- 0.1 mmol/l. Conclusion: The angiotensin II antagonist losartan lowers blood pressure and displays a favorable renal profile in hypertensive patients with renal disease.