¹Department of Nephrology, Saitama Medical College, Iruma, Saitama, Japan

Correspondence: Professor H Suzuki, Department of Medicine, Saitama Medical College, 38 Moro-hongo Moroyama, Iruma, Saitama 350-0495, Japan. E-mail: iromichi@saitama-med.ac.jp

Received 25 October 2006; Revised 9 March 2007; Accepted 24 March 2007; Published online 26 July 2007.

Abstract

Cardiovascular diseases constitute major cause of death in chronic kidney diseases (CKDs). We examined the effects of angiotensin inhibition either with angiotensin-converting enzyme inhibitor or with angiotensin receptor blocker on patient prognosis and heart-ankle pulse wave velocity (haPWV) in CKDs. Randomized controlled study was performed on 102 patients with non-diabetic CKDs. Patients were divided into two groups with or without angiotensin inhibition, and followed until death, creatinine clearance was halved or starting renal replacement therapy, whichever occurred first. For 4 years, haPWV was assessed repeatedly in the surviving patients. While both groups showed well blood pressure control throughout 4 years (1291 to 1312/711 to 732 mm Hg), renal prognosis was better in angiotensin inhibition group (P<0.05). In addition, angiotensin inhibition reduced cardiovascular and renal death (P<0.05). Age, sex, heart rate, systolic blood pressure and proteinuria were correlated to haPWV (R²=0.76, P<0.0001). Although haPWV was similar between two groups at the start of the study (109831 vs 109437 cm/s), it was higher in patients without angiotensin inhibition than that with angiotensin inhibition 4 years later (103438 cm/s (n=28) vs 124237 cm/s (n=23), P<0.01). The present results provided the evidence that angiotensin inhibition arrested a time-dependent elevation of haPWV in non-diabetic CKDs, conferring organ protection. Furthermore, our data indicated that angiotensin inhibition improved patient prognosis in non-diabetic chronic kidney diseases with mild-to-moderate renal dysfunction.