PMID- 10070908
OWN - NLM
STAT- MEDLINE
DCOM- 19990311
LR  - 20190815
IS  - 0272-6386 (Print)
IS  - 0272-6386 (Linking)
VI  - 33
IP  - 3
DP  - 1999 Mar
TI  - A subdepressor low dose of ramipril lowers urinary protein excretion without 
      increasing plasma potassium.
PG  - 450-7
AB  - Angiotensin-converting enzyme (ACE) inhibitors are increasingly administered to 
      patients with chronic renal disease. One issue of concern with the use of ACE 
      inhibitors in patients with impaired renal function is the possible development 
      of hyperkalemia. We reasoned that the impact of ACE inhibitors on plasma 
      potassium could be minimized by administering these agents at very low doses. To 
      examine this issue, we investigated the effect of a low dose of ramipril (1.25 mg 
      orally once daily) and an eight-fold higher dose (10 mg orally once daily) on 
      plasma potassium in 13 patients with proteinuria and mild chronic renal 
      insufficiency. The study was divided into four phases: placebo (4 weeks), 
      low-dose ramipril (8 weeks), high-dose ramipril (8 weeks), and washout phase (4 
      weeks). With the low dose of ramipril, urinary protein excretion decreased 
      significantly as early as after 1 week of administration (from 4.4 +/- 0.5 to 3.7 
      +/- 0.4 g/24 h; P < 0.025) and did not decrease any further thereafter even when 
      the dose was increased eight-fold. Mean arterial blood pressure and plasma 
      potassium did not change significantly with the low dose of ramipril, whereas 
      with the higher dose, mean arterial blood pressure decreased significantly (from 
      107 +/- 2.0 to 100 +/- 2.0 mm Hg, P < 0.005), and plasma potassium increased 
      significantly (from 4.53 to 4.78 mEq/L, P < 0.05). We conclude that a low dose of 
      ramipril can reduce proteinuria to the same extent as an eight-fold higher dose 
      without significantly lowering blood pressure or increasing plasma potassium. 
      This latter feature may be advantageous for the treatment of patients at risk for 
      hyperkalemia who require ACE inhibitors.
FAU - Keilani, T
AU  - Keilani T
AD  - Northwestern University Medical School, VA Chicago Health Care System, Lakeside 
      Division, IL 60611, USA.
FAU - Danesh, F R
AU  - Danesh FR
FAU - Schlueter, W A
AU  - Schlueter WA
FAU - Molteni, A
AU  - Molteni A
FAU - Batlle, D
AU  - Batlle D
LA  - eng
PT  - Clinical Trial
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am J Kidney Dis
JT  - American journal of kidney diseases : the official journal of the National Kidney 
      Foundation
JID - 8110075
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 4964P6T9RB (Aldosterone)
RN  - EC 3.4.15.1 (Peptidyl-Dipeptidase A)
RN  - EC 3.4.23.15 (Renin)
RN  - L35JN3I7SJ (Ramipril)
RN  - RWP5GA015D (Potassium)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aldosterone/*blood
MH  - Analysis of Variance
MH  - Angiotensin-Converting Enzyme Inhibitors/*administration & dosage
MH  - Drug Administration Schedule
MH  - Female
MH  - Humans
MH  - Kidney Failure, Chronic/blood/*drug therapy/enzymology
MH  - Male
MH  - Middle Aged
MH  - Peptidyl-Dipeptidase A/blood
MH  - Potassium/*blood
MH  - Proteinuria/blood/*drug therapy/enzymology
MH  - Ramipril/*administration & dosage
MH  - Renin/blood
MH  - Treatment Outcome
EDAT- 1999/03/10 00:00
MHDA- 1999/03/10 00:01
CRDT- 1999/03/10 00:00
PHST- 1999/03/10 00:00 [pubmed]
PHST- 1999/03/10 00:01 [medline]
PHST- 1999/03/10 00:00 [entrez]
AID - S0272-6386(99)70181-2 [pii]
AID - 10.1016/s0272-6386(99)70181-2 [doi]
PST - ppublish
SO  - Am J Kidney Dis. 1999 Mar;33(3):450-7. doi: 10.1016/s0272-6386(99)70181-2.