LONG-TERM TREATMENT WITH EITHER ENALAPRIL OR NITRENDIPINE STABILIZES ALBUMINURIA AND INCREASES GLOMERULAR-FILTRATION RATE IN NON-INSULIN-DEPENDENT DIABETIC-PATIENTS

The effect of short- (98 days) and long-term (1 year) treatment with n itrendipine (10 to 40 mg/d) and enalapril (5 to 20 mg/d) on kidney fun ction was studied prospectively in a parallel group design in 16 micro albuminuric non-insulin-dependent diabetic patients with mild hyperten sion and biopsy-proven diabetic glomerulopathy. At the end of the shor t-term treatment period diastolic blood pressure significantly decreas ed from 95.4 +/- 2.5 mm Hg to 83.5 +/- 3.5 mm Hg (P < 0.001) in the ni trendipine group and from 96.7 +/- 2.5 to 86.7 +/- 5.6 mm Hg (P < 0.00 1) in the enalapril group. Both overnight urinary albumin excretion ra te and albumin fractional clearance tended to increase in the nitrendi pine group and to decrease in the enalapril group, whereas the glomeru lar filtration rate and the renal plasma flow were similar to baseline in both study groups. At the end of the long-term treatment period di astolic blood pressure significantly decreased from 95.4 +/- 2.5 mm Hg to 86.0 +/- 6 mm Hg (P < 0.005) in the nitrendipine group and from 96 .7 +/- 2.1 to 90.8 +/- 4.3 mm Hg (P < 0.05) in the enalapril group. Ov ernight urinary albumin excretion and albumin fractional clearance wer e similar to baseline in both study groups. The glomerular filtration rate significantly increased from 70.2 +/- 14.2 to 96.8 +/- 20.4 (P < 0.05) in the nitrendipine group and from 58.9 +/- 10.7 to 78.5 +/- 11. 0 (P < 0.05) in the enalapril group. The renal plasma flow also signif icantly increased from 456.6 +/- 165.3 to 597.2 +/- 178.9 (P < 0.01) i n the nitrendipine group. Both treatments were well tolerated. Thus, l ong-term treatment with nitrendipine and enalapril, in addition to con trolling blood pressure, prevented urinary albumin excretion from incr easing with time and increased the glomerular filtration rate. (C) 199 4 by the National Kidney Foundation, Inc.