What is the clinical evidence from this study?

Study design: RCT. Population: Non-diabetic chronic renal failure with hypertension (n=100). Intervention: Enalapril vs. β blockers (acebutolol 400 mg/day or atenolol 100 mg/day). Primary outcome: Development of end stage renal failure (RR 3.5, 95% CI 1.5 to 7.6, p=<0.05).

What question did this study set out to answer?

To compare the efficacy of the angiotensin converting enzyme inhibitor enalapril versus beta blockers in slowing progression to end stage renal failure in non-diabetic patients with chronic renal failure.

October 1, 1994BMJOpen Access

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

Q: What are the key findings of this study?

Enalapril significantly reduced the progression to end-stage renal failure compared to beta-blockers in hypertensive patients with non-diabetic chronic renal failure (19% vs 35%, p<0.05).

Q: What question did this study set out to answer?

To compare the efficacy of the angiotensin converting enzyme inhibitor enalapril versus beta blockers in slowing progression to end stage renal failure in non-diabetic patients with chronic renal failure.

View Full Paper

Ask AI

Bookmark

Key result

Enalapril significantly reduced the progression to end-stage renal failure compared to beta-blockers in hypertensive patients with non-diabetic chronic renal failure (19% vs 35%, p<0.05).

Why the study?

Does enalapril reduce the development of end stage renal failure in hypertensive patients with non-diabetic chronic renal failure compared to beta blockers?

Population

100 hypertensive patients with non-diabetic chronic renal failure (initial serum creatinine 200-400 μmol/l)

Comparison

Enalapril combined with frusemide vs Beta blockers combined with frusemide

Design

RCT, randomised, Open

Follow-up

three years

Authors

THT HannedoucheHôpital Necker-Enfants Malades PLPaul LandaisUniversité de Montpellier BGBernard GoldfarbNOSM University

Discussion

Member takes

Implication

Enalapril should be prioritized over beta-blockers in hypertensive non-diabetic CKD; extends ACE inhibitor renoprotection independent of BP control.

Key Points

To compare the efficacy of the angiotensin converting enzyme inhibitor enalapril versus beta blockers in slowing progression to end stage renal failure in non-diabetic patients with chronic renal failure.
Open randomised multicentre trial conducted across outpatient departments of six French hospitals with a three-year follow-up.
Enrolled 100 hypertensive patients with chronic renal failure (initial serum creatinine 200–400 μmol/l), randomised to enalapril (n=52) or beta blockers (n=48), each combined with frusemide and supplemental antihypertensive agents if diastolic blood pressure exceeded 90 mm Hg.
End stage renal failure occurred in 10 of 52 patients receiving enalapril compared to 17 of 48 receiving conventional beta blocker treatment, with cumulative renal survival significantly higher in the enalapril group (P<0.05).
The decline in reciprocal serum creatinine concentration was significantly slower in enalapril-treated patients (-4.17 × 10⁻⁵ l/μmol/month) than in conventionally treated patients (-6.89 × 10⁻⁵ l/μmol/month; P<0.05), despite no differences in blood pressure between groups.

Study Design

Type

RCT (n=100)

Blinding

Open-label

Randomization

Random permuted blocks within strata

Multicenter

Yes

Structured PICO

Does enalapril reduce the development of end stage renal failure in hypertensive patients with non-diabetic chronic renal failure compared to beta blockers?

Population

100 hypertensive patients with non-diabetic chronic renal failure (initial serum creatinine 200-400 μmol/l)

Intervention

Enalapril combined with frusemide (and calcium blocker or centrally acting drug if diastolic pressure remained above 90 mm Hg)

Comparator

Beta blockers (conventional treatment) combined with frusemide (and calcium blocker or centrally acting drug if diastolic pressure remained above 90 mm Hg)

Outcome

Development of end stage renal failurehard clinical

Main Result

Effect estimate: RR 3.5 (95% CI 1.5 to 7.6)

Absolute Event Rate: 19% vs 35%

p-value: p=<0.05

Enalapril slows progression to end stage renal failure compared to beta blockers in hypertensive patients with non-diabetic chronic renal failure, independent of blood pressure control.

Limitations

Open-label design
Did not stratify patients according to underlying nephropathies due to sample size constraints
Not restricting protein intake could have favored the enalapril group
Lower statistical power for inulin clearance analysis due to missing data and withdrawals

Cite This Study

Hannedouche et al. (1994) conducted an RCT in Non-diabetic chronic renal failure with hypertension (n=100). Enalapril vs. β blockers (acebutolol 400 mg/day or atenolol 100 mg/day) was evaluated on Development of end stage renal failure (RR 3.5, 95% CI 1.5 to 7.6, p=<0.05). Enalapril significantly reduced the progression to end-stage renal failure compared to beta-blockers in hypertensive patients with non-diabetic chronic renal failure (19% vs 35%, p<0.05).

synapsesocial.com/papers/6a0f36d714089a5783bddccc https://doi.org/10.1136/bmj.309.6958.833

Topics

Hypertension management

View Full Paper

Ask AI

Bookmark

Implication

Enalapril should be prioritized over beta-blockers in hypertensive non-diabetic CKD; extends ACE inhibitor renoprotection independent of BP control.

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider