A RANDOMIZED TRIAL OF CAPTOPRIL FOR MICROALBUMINURIA IN NORMOTENSIVE ADULTS WITH SICKLE-CELL-ANEMIA

PURPOSE: Nephropathy is a common complication of sickle cell anemia an d is often preceded by proteinurea. Our aim was to evaluate the effect of angiotensin-converting enzyme inhibition on microalbuminuria in si ckle cell patients. PATIENTS AND METHODS: We performed a randomized, d ouble-blind, placebo-controlled trial in ?:! normotensive patients wit h sickle cell anemia and persistent microalbuminuria. Patients receive d captopril (25 mg/day) or placebo and were followed up for 6 months. Albuminuria, blood pressure, and serum creatinine and hemoglobin conce ntrations were measured at baseline and at 1, 3, and 6 months. The pri mary outcome variable was the 6-month change in albuminuria between th e two groups. RESULTS: Baseline albuminuria was 121 (SD 66) mg per 24 hours in the captopril group and 107 (SD 86) mg per 24 hours in the pl acebo group. Microalbuminuria decreased from baseline in the captopril group but increased in the placebo group. The mean absolute change an d the mean percentage change in microalbuminuria were significantly di fferent between the two groups at 6 months (absolute change -45 mg per 21 hours in the captopril group versus +18 mg per 24 hours in the pla cebo group, P < 0.01; and percentage change -37% in the captopril grou p versus + 17% in the placebo group, P < 0.01). The 95% confidence int ervals (CI) for the difference in albuminuria between the two groups w ere 63 (CI 40 to 86) mg per 24 hours for the mean absolute change and 54% (CI 22% to 85%) for the mean percentage change. Blood pressure dec reased slightly from baseline in captopril-treated patients and did no t change in the placebo group. The change was significantly different between the two groups only for diastolic blood pressure at 6 months ( P < 0.01). CONCLUSION: Captopril reduces albuminuria and slightly decr eases blood pressure in patients with sickle cell anemia. More studies are required to demonstrate the sustained benefit on protein excretio n. (C) 1998 by Excerpta Medica, Inc.