Renal protective potential of antihypertensive drugs.

The objective of this review is to discuss recent experimental and clinical data concerning the effectiveness of antihypertensive drugs in preventing or delaying renal changes caused by diabetes mellitus and hypertension and to examine possible future developments. A brief description of the mechanisms involved in the development of renal failure in diabetes and hypertension is included. Evidence is presented to show that in addition to renoprotection offered by reduction in arterial pressure, some antihypertensive agents may give more nephroprotection. This added renoprotective potential of antihypertensive agents, which are either already in use or are being developed, is discussed. The nephroprotective action of conventional antihypertensive drugs, such as beta-blockers, calcium antagonists and angiotensin-converting enzyme inhibitors is briefly reviewed. It is noted that several studies indicate that angiotensin-converting enzyme inhibitors may be more effective in preventing or retarding renal failure than other conventional drugs. The renoprotective potential of newly developed agents, such as angiotensin II Type 1 receptor antagonists, vasopeptidase inhibitors and endothelin receptor antagonists is also examined. Emphasis is placed on a possible superior renoprotective effect of combination therapy over monotherapy.