Effect of Lisinopril on the progression of renal insufficiency in mild proteinuric non-diabetic nephropathies

Background. The aim of the study was to determine whether Lisinopril an ACE-inhibitor (ACEi), was more effective than other antihypertensive agents in slowing the progression of non-diabetic chronic renal diseases in patients with baseline proteinuria less than or equal to1.0 g/day. Methods. In an open, multicentre study all eligible patients entered a 3 months run-in phase during which antihypertensive therapy (with exclusion of ACEi) was adjusted in order to obtain a supine diastolic blood pressure less than or equal to 90 mmHg and urinary protein excretion and renal function stability were verified. One hundred and thirty-one patients with chronic renal insufficiency (Cler between 20-50 ml/min) because of primary reno-parenchymal diseases and proteinuria less than or equal to1.0 g/day, were randomized to Lisinopril (L = 66) or alternative antihypertensive therapy (C=65), Changes in renal function were assessed by inulin (Clin) clearance. Results. During the follow-up period of 22.5 +/- 5.6 months, Clin did not change significantly in group L (-1.31 +/- 0.6 ml/min/1.73 m(2)) differing significantly from group C in which it declined markedly (-6.71 +/- 3.6 ml/min/1.73 m(3)) (P < 0.04). Seven patients experienced adverse events that prompted discontinuation of treatment: four in group L and three in group C; in addition seven patients showed severe deterioration in renal function requiring dialysis: two in group L and five in group C, The overall risk of the combined end-points: need fur dialysis or halving of GFR was significantly higher in group C: vcr sus group L. During the study the mean value for systolic blood pressure was 137.8 <plus/minus> 14.6 SD mmHg in group L and 140.8 +/- 14.1 SD mmHg in group C; the mean difference between groups, during and at the end of the study, was 2 mmHg (NS). The mean diastolic blood pressure during the study was 83.8 +/- 8.6 SD mmHg in group L and 84.3 +/- 7.56 SD mmHg in group C; during and at the end of the study the mean diastolic difference between groups was 1 mmHg. Conclusion. This study, employing a sensitive measurement of renal function and with similar blood pressure in both groups, provides support to the hypothesis that ACEi have a specific renoprotective effect, in addition to blood pressure control, also in patients with mild proteinuria.