TY - JOUR
T1 - Effect of ramipril on blood pressure and protein excretion rate in normotensive nondiabetic patients with proteinuria
AU - Toto, Robert D.
AU - Adams-Huet, Beverly
AU - Fenves, Andrew Z.
AU - Mitchell, Helen C.
AU - Mulcahy, Wayne
AU - Smith, Ronald D.
N1 - Funding Information:
From the Department of Internal Medicine and the General Clinical Research Center, University of Texas Southwestern Medical Center at Dallas, Dallas, TX; Dallas Nephrology Associates Research Institute, Dallas, TX; Department of Cardiovascular~Renal Clinical Development, Hoechst-Roussel, Somerville, N J; and the Department of Medicine, Bowman-Gray School of Medicine, Salisbury, NC. Received February 20, 1996; accepted in revised form July 30, 1996. Supported by a grant from Hoechst-Roussel Pharmaceuticals and National Institutes of Health GCRC Grant No. MO1-RR006633. Address reprint requests to Robert D. Toto, MD, Department of Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75235-8856. © 1996 by the National Kidney Foundation, Inc. 0272-6386/96/2806-000653.00/0
PY - 1996/12
Y1 - 1996/12
N2 - Angiotensin-converting enzyme inhibitors reduce proteinuria in both normotensive and hypertensive patients with proteinuric renal disease. However, the mechanism of the antiproteinuric effect has not been clarified. We performed a prospective, double-blind, placebo-controlled, randomized crossover trial to test the hypothesis that the antiproteinuric effect of ramipril was due to an improvement in glomerular permselectivity independent of blood pressure and glomerular filtration rate. The effect of low-dose (1.25 mg/d) and high-dose (5 mg/d) ramipril was assessed in 15 normotensive nondiabetic patients with proteinuria (> 150 mg/d). The study was divided into four 12-week periods: placebo, high- or low-dose ramipril, crossover to low- or high-dose ramipril, and placebo. Blood pressure, glomerular filtration rate, renal plasma flow rate, urinary protein excretion rate, and plasma angiotensin II levels were measured at the end of each period. Mean arterial pressure, urine protein to creatinine ratio, and albumin excretion rate decreased significantly during low- and high-dose ramipril. Glomerular filtration rate and renal plasma flow rate were not changed significantly. Plasma angiotensin II levels decreased with both low- and high-dose ramipril. There were no episodes of hypotension and only one subject developed cough during ramipril that did not require discontinuation of the study drug. In conclusion, administration of ramipril in both low and high doses lowered blood pressure and reduced proteinuria in this cohort of normotensive patients with a variety of proteinuric renal diseases. The antiproteinuric effect of ramipril is probably mediated by a reduction in glomerular capillary pressure.
AB - Angiotensin-converting enzyme inhibitors reduce proteinuria in both normotensive and hypertensive patients with proteinuric renal disease. However, the mechanism of the antiproteinuric effect has not been clarified. We performed a prospective, double-blind, placebo-controlled, randomized crossover trial to test the hypothesis that the antiproteinuric effect of ramipril was due to an improvement in glomerular permselectivity independent of blood pressure and glomerular filtration rate. The effect of low-dose (1.25 mg/d) and high-dose (5 mg/d) ramipril was assessed in 15 normotensive nondiabetic patients with proteinuria (> 150 mg/d). The study was divided into four 12-week periods: placebo, high- or low-dose ramipril, crossover to low- or high-dose ramipril, and placebo. Blood pressure, glomerular filtration rate, renal plasma flow rate, urinary protein excretion rate, and plasma angiotensin II levels were measured at the end of each period. Mean arterial pressure, urine protein to creatinine ratio, and albumin excretion rate decreased significantly during low- and high-dose ramipril. Glomerular filtration rate and renal plasma flow rate were not changed significantly. Plasma angiotensin II levels decreased with both low- and high-dose ramipril. There were no episodes of hypotension and only one subject developed cough during ramipril that did not require discontinuation of the study drug. In conclusion, administration of ramipril in both low and high doses lowered blood pressure and reduced proteinuria in this cohort of normotensive patients with a variety of proteinuric renal diseases. The antiproteinuric effect of ramipril is probably mediated by a reduction in glomerular capillary pressure.
KW - Angiotensin-converting enzyme inhibition
KW - blood pressure
KW - glomerular disease
KW - proteinuria
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U2 - 10.1016/S0272-6386(96)90382-0
DO - 10.1016/S0272-6386(96)90382-0
M3 - Article
C2 - 8957034
AN - SCOPUS:0029849015
SN - 0272-6386
VL - 28
SP - 832
EP - 840
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -