Renal and cardiac effects of antihypertensive treatment with ramipril versus metoprolol in autosomal dominant polycystic kidney disease.
Autosomal dominant polycystic kidney disease (ADPKD) affects ∼12.5 million people worldwide. Forty percent of patients are diagnosed by 45 years of age. ADPKD is the fourth most common cause for end-stage renal disease (ESRD) worldwide and this disease accounts for 5–10% of renal transplant recipients [1,2]. Therefore, any therapeutic modality that can slow down the natural course history of this disease would have a significant impact on patients’ well-being and would be financially cost-effective. The manuscript by Zeltner et al. in this issue attempts to determine if there is a difference between an angiotensinconverting enzyme (ACE) inhibitor (ramipril) and a beta blocker (metoprolol) when employing first-line therapy in ADPKD patients with hypertension. The study has a number of limitations; some of them recognized by the authors that could influence the conclusion are noted as follows: