The management of
hypertension and nephropathy, in both diabetes and other forms of renal disease, is usually based on blood pressure reduction through an
angiotensin-converting enzyme (
ACE) inhibitor-based treatment regimen. With particular respect to the choice of
ACE inhibitor drug, there are no definitive direct comparisons in the treatment of renal disease. In terms of blood pressure reduction, however, there is evidence that
spirapril is at least as effective as the reference
ACE inhibitor,
enalapril. However, patients with
diabetic nephropathy and/or
chronic renal failure are at potential risk from
drug accumulation if the preferred agent relies predominantly on glomerular filtration for its elimination. In this respect
spirapril may have an advantage because it has been shown that there are no clinically relevant increases in the
spirapril(at) concentrations (24 h post-dose) even in the setting of advanced
renal failure (
creatinine clearance <20 ml/min). Thus, there is no requirement to modify the dose and no concerns about
drug accumulation or the potential for exaggerated therapeutic or adverse effects. In summary, an
ACE inhibitor drug is seen as an integral component of the
drug treatment regimen for patients with nephropathy. Where there is
renal failure it may be prudent to administer a
drug, such as
spirapril, which also has alternative elimination mechanisms.