Randomised controlled trial of enalapril and β blockers in non- diabetic chronic renal failure

Abstract Objective : To compare the ability of angiotensin converting enzyme inhibitors and β blockers to slow the development of end stage renal failure in non-diabetic 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 μmol/l). 52 randomised to enalapril and 48 to β blockers (conventional treatment). Interventions : Enalapril or β 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 (- 6.89x10 -5 l/μmol/month) than in the enalapril group (-4.17x10 -5 l/μmol/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 β blockers. This effect was probably not mediated through controlling blood pressure.