Nephrosclerosis constitutes a major cause of
end-stage renal disease. Independently of blood pressure control,
ACE inhibitors (ACEIs) are considered to be more nephroprotective than other
antihypertensive agents. We have reviewed the long-term evolution of renal function in our series of essential hypertensive patients diagnosed as having
nephrosclerosis when first seen in our unit. The analysis was performed depending on whether or not their
antihypertensive therapy contained an ACEI alone or in combination for the whole follow-up. The end point was defined as the confirmation of a 50% reduction in
creatinine clearance or entry in a dialysis program. A historical cohort of 295 patients was included in the analysis. Mean follow-up was 7.4+/-3.9 years. Diabetes prevalence was higher in ACEI-treated patients (25.7% versus 7.1%, P=0.000), but the diagnosis of
diabetic nephropathy could not be confirmed on clinical grounds, including renal biopsy. Twenty-three out of 183 (12.6%) patients in the ACEI group and 23 out of 112 (20.5%) patients in the non-ACEI group experienced a renal event (P=0.0104 by log rank test). Similar results were observed when only nondiabetic patients were considered for the analysis. Cox regression analysis showed that baseline serum
creatinine, absence of ACEI administration, mean
proteinuria during follow-up, and age were independent predictors for the development of a renal event. In hypertensive
nephrosclerosis,
therapy containing an ACEI alone or in combination significantly reduces the incidence of renal events. This effect is independent of blood pressure control.