Comparison of Long-Term Therapeutic Effect of an ACE Inhibitor, Temocapril, with That of a Diuretic on Microalbuminuria in Non-Diabetic Essential Hypertension

• Published in: Hypertension Research Vol. 23; no. 6; pp. 593 - 600
• Main Authors: KITA, Eiko, TAKIZAWA, Toshikazu, KOSAKA, Tomoichiro, TAKASAKI, Izumi, SHIONOIRI, Hiroshi
• Format: Journal Article
• Language: English
• Published: England The Japanese Society of Hypertension 01.11.2000
• Subjects: ACE inhibition; Albuminuria; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Creatinine - urine; diuretic; Diuretics; essential hypertension; Humans; Hypertension - drug therapy; Hypertension - urine; microalbuminuria; Sodium Chloride Symporter Inhibitors - therapeutic use; temocapril; Thiazepines - therapeutic use; Time Factors; Trichlormethiazide - therapeutic use
• ISSN: 0916-9636; 1348-4214; 1348-4214
• DOI: 10.1291/hypres.23.593

Many investigators have reported that angiotensin-converting enzyme (ACE) inhibitors have antiproteinuric effects and retard the progression of renal impairment in diabetic patients. On the other hand, those effects of ACE inhibitors have not been well established in patients with essential hypertension. This study was conducted to prospectively evaluate whether an ACE inhibitor, temocapril, could modify the urinary microalbumin excretion rate (UAE) in hypertensive outpatients who had no signs of renal impairment. To compare the long-term effect of temocapril with that of a diuretic on UAE, hypertensive patients treated with a diuretic (trichlormethiazide) were enrolled in a prospective study if they had normal serum creatinine levels and no overt proteinuria during a 3-month screening period. A urinary microalbumin-to-urinary-creatinine ratio (mg albumin/mmol Cr) was used as an estimate of UAE. Patients visited the hospital monthly to determine blood pressure (BP) and UAE. After baseline observation during the treatment with the diuretic, the subjects were randomly divided into two groups. In group A, the diuretic was switched to temocapril, 2 to 4mg once daily for 12months. In group B, the subjects continued to receive the diuretic for an additional 12months. Seventy-six outpatients (41 men and 35 women; mean age, 59.0±1.4 years) with essential hypertension entered the study. The effects of temocapril on BP appeared to be clinically similar to those of the trichlormethiazide, but the use of temocapril significantly decreased UAE. In group A (n=37), UAE decreased significantly (p<0.01) from the baseline value of 4.19±0.37mg albumin/mmol Cr to 2.47±0.29 and 2.68±0.28mg albumin/mmol Cr at the 6th and 12th month of temocapril therapy, respectively. In contrast, in group B (n=39) UAE was unchanged (baseline, 4.16±0.63mg albumin/mmol Cr; 6 months, 4.92±0.72; 12 months, 4.71±0.74). These results indicate that long-term therapy with temocapril may be superior in reducing UAE than is diuretic therapy in patients with essential hypertension who had no signs of renal impairment. (Hypertens Res 2000; 23: 593-600)