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June 1989

Efficacy and Renal Effects of Enalapril Therapy for Hypertensive Patients With Chronic Renal Insufficiency

Author Affiliations

Biloxi, Miss

Arch Intern Med. 1989;149(6):1462-1463. doi:10.1001/archinte.1989.00390060166044

To the Editor.—On the surface, the recent article by Abraham and colleagues1 would seem to address a provocative question: whether or not the progression of nondiabetic chronic renal disease can be affected by the administration of the angiotensin-converting enzyme inhibitor (ACEI) enalapril. Closer inspection reveals little data concerning this patient group. Of the 10 patients able to complete short-term therapy, 4 actually had diabetic nephropathy and only 2 of the 6 patients with nondiabetic renal disease had significant proteinuria (Nos. 4 and 10). Only 1 of these 2 patients (No. 4) seemed to have a significant reduction in proteinuria, but he was withdrawn from the study before the long-term phase of the study could be completed. The authors state that "the rate of progression of renal insufficiency seemed to slacken in 3 of 4 patients with diabetic nephropathy," based on changes in slopes of serum creatinine curves (the

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