LONG-TERM ENALAPRIL THERAPY IN PATIENTS WITH CHRONIC-RENAL-FAILURE ONA LOW-PROTEIN DIET - A PROSPECTIVE RANDOMIZED COMPARISON WITH METOPROLOL

The effect of enalapril (5-10 mg/day) on the progression of chronic re nal failure (CRF) was compared with that of metoprolol (40-120 mg/day) in 28 patients for 24 months in a prospective study. Throughout the s tudy, there was no significant difference between the 2 groups in prot ein intake and urinary sodium excretion. But there was a significant d ifference between the 2 groups in diastolic and mean arterial blood pr essure at 6 months. In the serum creatinine level, there was a signifi cant difference between the 2 groups at 6, 12, 18, and 24 months. In c reatinine clearance, there was a significant difference between the 2 groups at 24 months. In addition, the progression of CRF was significa ntly faster in the metoprolol group than the enalapril group as estima ted from the slope of creatinine clearance (p < 0.05) and the slope of glomerular filtration rate (p < 0.0005). In urinary protein excretion , there was a significant difference between the 2 groups at 6 and 18 months (p < 0.05). These findings indicate that enalapril has a suppre ssive effect on the progression of CRF and also has an antiproteinuric effect by a mechanism independent of its antihypertensive effect.