Role of angiotensin-converting-enzyme inhibition in patients with renal disease

Clinical studies evaluating the benefits of angiotensin-converting-enzyme ( ACE) inhibitor therapy in patients likely,to develop renal disease are revi ewed. Patients with diabetes or hypertension are at increased risk for developmen t of renal disease. In patients with diabetic nephropathy, captopril therap y was associated with a 50% reduction in the, risk of death, dialysis, and transplantation and a significantly smaller increase in serum creatinine co mpared with placebo. Therapy with enalapril or lisinopril has been shown to limit the progression of renal disease in normoalbuminuric patients with d iabetes. Long-term therapy with enalapril (up to seven years) has demonstra ted the ability to preserve renal function in patients with diabetes and mi croalbuminuria. Over 4.5 years, patients with diabetes and at least one oth er cardiovascular risk factor had significant reductions in the risk Of ove rt nephropathy With ramipril therapy compared with placebo. In addition, ra mipril is associated with preservation of renal function in patients with n ondiabetic neuphropathy. Evidence suggesting a dissociation of the renal he modynamic and antiproteinuric effects of ACE inhibition is presented. These positive effects of ACE inhibition cannot be explained by reductions in bl ood pressure alone. ACE inhibitors have renoprotective properties: beyond systemic blood: press ure reduction.