Effect of ramipril on blood pressure and protein excretion rate in normotensive nondiabetic patients with proteinuria

Robert D. Toto, Beverly Adams-Huet, Andrew Z. Fenves, Helen C. Mitchell, Wayne Mulcahy, Ronald D. Smith

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)832-840
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume28
Issue number6
DOIs
StatePublished - Dec 1996

Keywords

  • Angiotensin-converting enzyme inhibition
  • blood pressure
  • glomerular disease
  • proteinuria

ASJC Scopus subject areas

  • Nephrology

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