Treatment of hypertension with ramipril in children with renal diseases (original) (raw)

2002

Abstract

ABSTRACT The purpose of the study was to investigate the effect of long-acting ACE-inhibitor ramipril on blood pressure (BP) and proteinuria in children with renal hypertension.We have investigated 15 children and adolescents (mean age 13.7, range 5.0 - 19.8 yrs, 9 girls) with chronic renal diseases (polycystic kidney diseases, glomerulopathies, uropathies) and hypertension. The children have been treated prospectively with ramipril monotherapy for 6 months. BP has been evaluated using ambulatory blood pressure monitoring (ABPM, oscillometric device SpaceLabs 90207). Hypertension was defined as systolic and/or diastolic daytime and/or night-time mean BP ≥ 95.pc according Soergel et al. (J Pediatr 1997;130:178-184). Proteinuria was measured in 24 hr urine. Glomerular filtration rate (GFR) was assessed using Schwartz formula. Ramipril was given once daily, the starting dose was 1.5 mg/m2/24 hr and this dose was increased after one month if the BP did not dropped below 95.pc.Mean arterial BP decreased in all children after 6 months of ramipril treatment. The mean BP fall was 10.5 and 10.3 mmHg for daytime systolic and daytime diastolic BP resp. and 8.0 and 7.7 mmHg for night-time systolic and night-time diastolic BP resp. In 9 children (60 %) the BP completely normalised (i.e. all BP values < 95.pc) at the end of the study. The mean ramipril dose at 6 months was 2.5 mg/m2/24 hr. Proteinuria decreased in 10 children (67 %), the mean decrease was 176 mg/m2/24 hrs ranging from -1168 to +166. GFR and serum potassium did not change significantly. Only one child (7 %) developed a cough.In conclusion, ramipril is an effective and safe antihypertensive drug in children with renal hypertension. The antiproteinuric effect is limited to ca. 2/3 of the patients. Despite the limited number of probands this prospective study is the largest one on the long-term antihypertensive and antiproteinuric effects of ramipril in children.Supported by grant IGA NE/6295-3 MZ Czech Republic

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