Authors: T. Seeman; J. Dušek; K. Vondrák; H. Flögelová 1; P. Geier 1; J. Janda Authors‘ workplace: I. dětská klinika 2. LF UK a FN Motol, Praha přednosta doc. MUDr. J. Janda, CSc. Dětská klinika FN, Olomouc1přednosta prof. MUDr. V. Mihál, CSc. Published in: Čes-slov Pediat 2003; (4): 187-193. Category:
Arterial hypertension is a common complication of different chronic renal diseases. ACE-inhibitors are thedrug of choice in patients with renal hypertension due to their antiproteinuric and renoprotective effects. Ramiprilis a long-acting ACE-inhibitor, his efficacy has been proved in several clinical trials in adults. Data on efficacy andsafety of ramipril in children are very rare. The aim of the study was to investigate the effects of ramipril on bloodpressure (BP) and proteinuria in children with chronic renal diseases and renoparenchymal arterial hypertension.15 children and adolescents (mean age 13.7, range 5.0 - 19.8 years, 9 girls) with different chronic renal diseases(9 children with polycystic kidney diseases, 3 children with uropathies and 3 children with glomerulopathies) andarterial hypertension were treated in a prospective study with ramipril monotherapy for 6 months. BP wasevaluated using ambulatory blood pressure monitoring (oscillometric device SpaceLabs 90207). Hypertension wasdefined as systolic or diastolic daytime or night-time BP mean > 95th percentile for the normal paediatricpopulation according Soergel et al. Proteinuria was measured in 24 hrs urine and Schwartz formula was used toassess glomerular filtration rates (GFR) which was decreased in 3 children at the beginning of the study. The initialdose of ramipril was 1.5 mg/m2/24 hrs.Daytime diastolic BP decreased after 6 months of treatment in all children, daytime systolic and night-timesystolic in 14 children and night-time diastolic in 12 of 15 children. The mean decrease ofambulatory blood pressurewas 10.2 mm Hg for daytime systolic, 9.9 mm Hg for daytime diastolic, 8.7 mm Hg for night-time systolic and7.9 mm Hg for night-time diastolic BP. In 9 children (60 %) hypertension completely normalized (i.e. ambulatoryBP < 95th PC). Proteinuria decreased in 10 children (67 %), the mean decrease of proteinuria was 204 mg/m2/24 hrs.The greatest antiproteinuric effect was seen in patients with greatest initial proteinuria. The average ramipril dose
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