RESUMO
The objective of our study was to evaluate the changes of blood pressure (BP), urinary protein excretion (PRT/Cr) and renal function (GFR) after long-term administration of ACE inhibitor, ramipril. This prospective trial, a part of the European Multicentric Escape Study, included 14 patients (5 girls and 9 boys), mean-age 11 years, with congenital renal malformations. The basic inclusion criteria were stable chronic renal failure (CRF) and mean arterial pressure (MAP) above 50 percentile defined by 24-hour ABPM or earlier antihypertensive medication. The patients were studied 6 months before and up to 36 months after the introduction of ramipril therapy. The dosage of ramipril ranged from 4.7 to 7.7 mg/ m2 SBA, mean 37.8 (+/- 4.03) mg/m2 SBA. The patients were controlled every two months for BP, proteinuria and GFR, while 24-hour ABPM was performed in 6 months. The significant decrease of regular and 24-hour ambulatory blood pressure (ABP), systolic, diastolic and MAP, was found within the first months of treatment, while ramipril-induced reduction of proteinuria and slowing down of GFR were delayed. BP did not differ significantly among patients, but antiproteinuric effect and influence on GFR showed large individual variations. Antiproteinuric and antihypertensive effects of ramipril correlated with underlying proteinuria, GFR and blood pressure. However, there was no constant relationship between changes of proteinuria and BP. Ramipril has been shown to: lower BP significantly, decrease proteinuria slowly, and significantly decelerate GFR after 18 months of treatment. Considering favorable preliminary results of lower BP, decrease of proteinuria and decelerated GFR, an optimal renal protection by long-term therapy with ACE inhibitors may be expected in children with CRF caused by congenital renal malformations.
