ACE inhibitors and appearance of renal events in hypertensive nephrosclerosis

Nephrosclerosis constitutes a major cause of end-stage renal disease. Indep endently of blood pressure control, ACE inhibitors (ACEIs) are considered t o be more nephroprotective than other antihypertensive agents. We have revi ewed the long-term evolution of renal function in our series of essential h ypertensive patients diagnosed as having nephrosclerosis when first seen in our unit. The analysis was performed depending on whether or not their ant ihypertensive therapy contained an ACEI alone or in combination for the who le follow-up. The end point was defined as the confirmation of a 50% reduct ion in creatinine clearance or entry in a dialysis program. A historical co hort of 295 patients was included in the analysis. Mean follow-up was 7.4 /-3.9 years. Diabetes prevalence was higher in ACEI-treated patients (25.7% versus 7.1%, P=0.000), but the diagnosis of diabetic nephropathy could not be confirmed on clinical grounds, including renal biopsy. Twenty-three out of 183 (12.6%) patients in the ACEI group and 23 out of 112 (20.5%) patien ts in the non-ACEI group experienced a renal event (P=0.0104 by log rank te st). Similar results were observed when only nondiabetic patients were cons idered for the analysis. Cox regression analysis showed that baseline serum creatinine, absence of ACEI administration, mean proteinuria during follow -up, and age were independent predictors for the development of a renal eve nt. In hypertensive nephrosclerosis, therapy containing an ACEI alone or in combination significantly reduces the incidence of renal events. This effe ct is independent of blood pressure control.