Ramipril in the treatment of hypertension and proteinuria in children with chronic kidney diseases.
BACKGROUND
Angiotensin-converting enzyme inhibitors are the drugs of choice in renal hypertension. The efficacy and safety of ramipril in adults has been proved; however, data on effectiveness of ramipril in children are few. The aim of the present study was to investigate the effect of ramipril on blood pressure (BP) and proteinuria in children with chronic kidney diseases.


METHODS
A total of 31 children (median age 11.3 years, range 1.9-19.8 years) with various chronic nephropathies and hypertension or proteinuria were prospectively treated with ramipril for 6 months. Blood pressure was evaluated using ambulatory BP monitoring and hypertension was defined as mean BP equal to or greater than the 95th percentile for healthy children. Proteinuria was defined as protein excretion > or =100 mg/m(2)/24 h. The starting dose of ramipril was 1.5 mg/m(2)/24 h once daily. In 27 children it was given as monotherapy.


RESULTS
The median decrease in ambulatory BP was 11 mm Hg for daytime systolic, 10 mm Hg for daytime and nighttime diastolic, and 8 mm Hg for nighttime systolic BP. Hypertension normalized in 55% of the children. Proteinuria decreased in 84% of the children with pathologic proteinuria; the median decrease was 51%. A positive correlation was found between initial proteinuria and change of proteinuria (r = 0.95, P <.001). Glomerular filtration rate and serum potassium level did not change significantly. One child developed a cough that was believed to be related to ramipril.


CONCLUSIONS
Ramipril is an effective and safe drug in children with chronic kidney diseases associated with hypertension, proteinuria, or both.
Seeman
Tomás
T
First Department of Paediatrics, Prague University Hospital, V Uvalu 84, Motol, 15006 Prague 5, Czech Republic. tomas.seeman@lfmotol.cuni.cz
Dusek
Jirí
J
Vondrák
Karel
K
Flögelová
Hana
H
Geier
Pavel
P
Janda
Jan
J
D000293:Adolescent; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000187:drug effects; D003971:Diastole / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007223:Infant; D007674:Kidney Diseases / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy* / Q000503:physiopathology; D017257:Ramipril / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D017257:Ramipril