RANDOMIZED CONTROLLED TRIAL OF ENALAPRIL AND BETA-BLOCKERS IN NONDIABETIC CHRONIC-RENAL-FAILURE

Objective-To compare the ability of angiotensin converting enzyme inhibitors and beta blockers to slow the development of end stage renal failure in nondiabetic patients with chronic renal failure. Design-Open randomised multicentre trial with three year follow up. Setting-Outpatient departments of six French hospitals. Patients-100 hypertensive patients with chronic renal failure (initial serum creatinine 200-400 mu mol/l). 52 randomised to enalapril and 48 to beta blockers (conventional treatment). Interventions-Enalapril or beta blocker was combined with frusemide and, if necessary, a calcium blocker or centrally acting drug in patients whose diastolic pressure remained above 90 mm Hg. Results-17 patients receiving conventional treatment and 10 receiving enalapril developed end stage renal failure. The cumulative renal survival rate was significantly better in the enalapril group than in the conventional group P<0.05). The slope of the reciprocal serum creatinine concentration was steeper in the conventionally treated patients (-6.89 x 10(-5)l/mu mol/month) than in the enalapril group (-4.17 x 10(-5)l/mu mol/month; P<0.05). No difference in blood pressure was found between groups. Conclusion-In hypertensive patients with chronic renal failure enalapril slows progression towards end stage renal failure compared with P blockers. This effect was probably not mediated through controlling blood pressure,