Ramipril shows favourable effects in hypertensive kids on maintenance haemodialysis

In hypertensive children undergoing maintenance haemodialysis, ramipril helps improve biomarkers of endothelial dysfunction and inflammation in addition to its blood pressure (BP)-lowering benefits, a study has found.

A total of 135 (53.3 percent male) children and adolescents with hypertension aged 7–15 years were randomized to treatment with either 2.5-mg once-daily ramipril (n=68) or placebo (n=67) for 16 weeks.

Researchers evaluated the serum concentrations of asymmetrical dimethylarginine and high-sensitivity C-reactive protein (hs-CRP)—markers of endothelial dysfunction and inflammation, respectively—as the primary outcome. They also assessed changes in interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), systolic and diastolic BP as secondary outcomes. Safety parameters included changes in potassium levels and incidence of hyperkalaemia.

Compared with placebo, ramipril produced significant reductions in serum levels of asymmetrical dimethylarginine (−79.6 percent; p<0.001), hs-CRP (−46.5 percent; p<0.001), IL-6 (−27.1 percent; p<0.001), and TNF-α (−51.7 percent; p<0.001).

There was a marked decrease in systolic and diastolic BP in both groups, with a greater reduction in children treated with ramipril (median between-group differences, −12.0 vs −9.0; p<0.001).

Analysis showed no evidence that the ramipril-induced changes in asymmetrical dimethylarginine, hs-CRP, IL-6, or TNF-α was correlated with BP reductions.

In terms of safety, there were no severe cases of hyperkalaemia or other serious treatment-associated adverse events recorded.