RANDOMIZED CONTROLLED TRIAL OF ENALAPRIL AND BETA-BLOCKERS IN NONDIABETIC CHRONIC-RENAL-FAILURE

Objective-To compare the ability of angiotensin converting enzyme inhi bitors and beta blockers to slow the development of end stage renal fa ilure in nondiabetic patients with chronic renal failure. Design-Open randomised multicentre trial with three year follow up. Setting-Outpat ient departments of six French hospitals. Patients-100 hypertensive pa tients with chronic renal failure (initial serum creatinine 200-400 mu mol/l). 52 randomised to enalapril and 48 to beta blockers (conventio nal treatment). Interventions-Enalapril or beta blocker was combined w ith frusemide and, if necessary, a calcium blocker or centrally acting drug in patients whose diastolic pressure remained above 90 mm Hg. Re sults-17 patients receiving conventional treatment and 10 receiving en alapril developed end stage renal failure. The cumulative renal surviv al rate was significantly better in the enalapril group than in the co nventional group P<0.05). The slope of the reciprocal serum creatinine concentration was steeper in the conventionally treated patients (-6. 89 x 10(-5)l/mu mol/month) than in the enalapril group (-4.17 x 10(-5) l/mu mol/month; P<0.05). No difference in blood pressure was found bet ween groups. Conclusion-In hypertensive patients with chronic renal fa ilure enalapril slows progression towards end stage renal failure comp ared with P blockers. This effect was probably not mediated through co ntrolling blood pressure,