COMPARATIVE RENAL HEMODYNAMIC-EFFECTS OF LISINOPRIL, VERAPAMIL, AND AMLODIPINE IN PATIENTS WITH CHRONIC-RENAL-FAILURE

We investigated the effects of lisinopril, verapamil, and amlodipine i n 26 hypertensive patients with chronic renal disease of varying etiol ogies. Blood pressure, urine protein excretion, glomerular filtration rate (GFR), and renal blood flow (RBF) (inulin and para-aminohippurate clearance) were determined before and after 2 to 3 months of therapy. All three agents lowered blood pressure with minimal side effects in many, but not all, patients. Patients who had a significant lowering o f blood pressure in response to lisinopril and verapamil had favorable renal hemodynamic responses as well - GFR remained stable, RBF was st able or increased, and filtration fraction, renal vascular resistance, and proteinuria tended to decrease. Patients whose blood pressure did not decrease had less favorable responses. In the small number of pat ients who received amlodipine, lowering of blood pressure was associat ed with a small decrease in GFR. Our results demonstrate a heterogenei ty in response to antihypertensive agents in patients with renal disea se. We therefore conclude that treatment of such patients should be in dividualized, and suggest that choice of therapy depend on adequate bl ood pressure response in conjunction with stabilization of renal funct ion and urine protein excretion. Our data do not support the use of a drug in these circumstances if it does not lower systemic blood pressu re.