Reversal of left ventricular hypertrophy with angiotensin converting enzyme inhibition in hypertensive patients with autosomal dominant polycystic kidney disease

Background. Hypertension occurs commonly and early in the natural history o f autosomal dominant polycystic kidney disease (ADPKD), affecting both rena l and patient outcome. Activation of the renin-angiotensin-aldosterone syst em due to cyst expansion and local renal ischaemia plays an important role in the development of ADPKD related hypertension and left ventricular hyper trophy (LVH), a known important risk factor for cardiovascular morbidity an d mortality. The aim of this study was to investigate the effects of an ang iotensin converting enzyme (ACE) inhibitor, enalapril, on renal function, b lood pressure and LVH in hypertensive ADPKD patients. Methods. Fourteen hypertensive ADPKD patients (II men, 3 women; mean age: 4 0 years) were included in the study. All patients had LVH and creatinine cl earance (Cer) greater than 50ml/min/1.73m(2). The patients were followed fo r 7 years on enalapril therapy. The effects of enalapril on renal function, blood pressure and LVH were investigated. Results. Baseline measurements of mean arterial pressure (MAP), Ccr and lef t ventricular mass index (LVMI) were 110+/-2mmHg, 84+/-6ml/min/1.73m(2) and 146 +/- 4 g/m(2), respectively. After one year of enalapril therapy there was a significant decrease in MAP (94 +/- 3 mmHg, P< 0.005) which remained stable until the end of the study at 7 years (94 +/- 1 mmHg, P < 0.005 vs b aseline). There was also a significant decrease in LVMI (131+/-6 g/m(2), P< 0.05) after year I which continued to decrease until the end of the study reaching 98 +/- 6 g/m(2) (P < 0.01 vs year 1 and baseline). Although Ccr re mained stable after year I, a significant decrease was observed after 7 yea rs of follow-up (59 +/- 6 ml/min, P<0.001 vs year 1 and baseline). Conclusions. ACE inhibition in hypertensive ADPKD patients provided long-te rm reversal of LVH in association with a mean 3.6 ml/min/year decline of Cc r. These preliminary results have potential important implications for card iovascular and renal protection in ADPKD.