Is ramipril the pril for diabetes and kidney disease?

Ramipril is safe and effective in the treatment of hypertension and heart f ailure, but this is not reviewed here. Ramipril is a lipophilic angiotensin -converting enzyme inhibitor suitable for once-daily administration. In add ition to decreasing angiotensin II and increasing bradykinin levels, ramipr il increases the levels of vasodilatory renal medullary neutral lipids and inhibits platelet-derived growth factor-induced proliferation of glomerulus cells. Ramipril also decreases transforming growth factor-beta in the kidn ey. Changes in kidney structure and proteinuria are characteristics of the streptozotocin (STZ) rat model of diabetes, and these are prevented by rami pril. In STZ diabetes, doses of ramipril that have no effect on blood press ure reverse vascular hypertrophy. In animal models of kidney failure (subto tal nephrectomy, stroke-prone spontaneously hypertensive rats), ramipril is renoprotective and some of this renoprotective effect is independent of bl ood pressure lowering. In humans, clinical doses of ramipril probably do no t modify glucose metabolism but do reduce the levels of LDL- and HDL-choles terol. In clinical trials of renal effects, ramipril has been shown to incr ease cortical nephron flow in hypertension and to reduce proteinuria in pat ients with and without diabetes and/or hypertension. Some of the smaller cl inical trials showed beneficial effects on kidney function with low doses o f ramipril that do not lower blood pressure. A large clinical trial in nond iabetic proteinuria, the Ramipril Efficacy in Nephropathy (REIN) trial, has shown that ramipril 1.25 mg/day, which does not lower blood pressure, arre sted the decline in glomerular filtration rate and prolonged the time to en d-stage renal failure. In diabetic patients who have had a previous cardiov ascular event or having one other cardiovascular risk factor, the MICRO-HOP E clinical trial showed that ramipril lowers the combined risk of myocardia l infarction, stroke and cardiovascular death by 25%. In conclusion. ramipr il has proven beneficial effects in kidney disease alone or in association with diabetes and in diabetes without kidney disease, and is the pril for d iabetes and kidney disease. (C) 2001 Prous Science. All rights reserved.