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Detrimental and beneficial effects of converting enzyme inhibitors on the kidney.

It has been recognized recently that even minor elevations in blood pressure contribute to progression of renal failure and that antihypertensive treatment retards progression. Despite suggestive experimental data, no unequivocal clinical evidence is available to date to document that converting enzyme inhibitors (CEIs) are superior to alternative antihypertensive agents with respect to halting progression. CEIs undoubtedly reduce albuminuria, independent of their effect on systemic blood pressure, and this is related to alteration of glomerular permselectivity. Recent experimental data suggest that growth processes in damaged kidneys are an important aspect of progression. It is a fascinating perspective, but yet unproven, that CEIs interfere with these processes.