Effects of combination therapy with losartan and benazepril in chronic renal disease patients with hypertension

Objective To observe the effects of combination therapy with losartan and benazepril in chronic renal disease patients with hypertension and stable renal insufficiency. Methods The study subjects comprised 55 patients of biopsy-proven chronic nephritis with systolic blood pressure (SBP) of 140-180 mm Hg, diastolic blood pressure (DBP) of 90-120 mm Hg, urinary protein excretion rate (UPE) of 1.0-3.0 g/d, and serum creatinine (Scr) of 132-265 μmol/L. The patients were randomly divided into 3 groups. 21 patients were treated with losartan 50 mg once a day. 23 patients were treated with benazepril 10 mg once a day. 11 patients were treated with losartan 50 mg and benazepril 10 mg once a day. All patients received the above therapy for 24 weeks. After 12 weeks′ treatment with monotherapy, 21 patients who did not reach target blood pressure (130/80 mm Hg) were treated with combination therapy with losartan or benazepril again for 12 weeks. Monotherapy continued in other patients for 12 weeks. SBP, DBP, UPE, Scr and serum uric acid (SUA) were measured during treatment period. Results Losartan or benazepril alone or in combination significantly lowered blood pressure and urinary protein excretion in patients with chronic nephritis ( P 0.05, P 0.01).Reduction of these parameters was most significantly in patients with combination therapy. Blood pressure control rate after end-of-treatment (week 12) is 81.4% in combination therapy group, 57.1% in losartan treatment group,47.8% in benazepril treatment group. After end-of-treatment (week 12), Scr in combination therapy group decreased significantly than that of monotherapy groups ( P 0.01). SUA in combination therapy group and losartan treatment group decreased significantly than that of benazepril group ( P 0.05, P 0.01). After combination therapy with losartan and benazepril in patients of monotherapy groups which not reaching target blood pressure, SBP, DBP, UPE, Scr and SUA drcreased significantly ( P 0.01).Compared with the patients of monotherapy groups reaching target blood pressure, reduction of UPE and Scr was most significantly in patients with combination of the two drugs after continuing treatment( P 0.05, P 0.01). There were not serious drug-related adverse experiences in the patients. Conclusion The combination of losartan and benazepril decreases SBP, DBP, UPE, Scr and SUA to a greater extent than losartan or benazepril alone in chronic renal disease patients with hypertension and stable renal insufficiency. There is an excellent safety and tolerability.