A comparison of the effects of ramipril and losartan on blood pressure control and left ventricle hypertrophy in patients with autosomal dominant polycystic kidney disease

Abstract

Background: Hypertension is frequently seen in autosomal dominant polycystic kidney disease (ADPKD), and it has a negative effect on renal progression. Hypertension and left ventricle hypertrophy (LVH) are related in terms of pathogenesis and their effects on renal progression. In this study, we aimed to compare the effects of losartan and ramipril on blood pressure (BP) control, LVH, and renal progression in patients with hypertensive ADPKD. Methods: Thirty-two ADPKD patients with ages ranging between 18 and 70 years who were stage 1-2 hypertensive were included in this study. Routine biochemical tests and echocardiography were obtained at first examination of the patients. Following these, the patients were randomized. One group was given losartan and the other ramipril. They were followed up for 1 year, and their echocardiographies and routine biochemical tests were repeated at the end of the year. Results: BP values decreased in both the groups at the end of the first year (p < 0.001). There was a statistically significant difference in LVH in both the groups at the end of the first year than at the beginning (losartan, p = 0.007; ramipril, p < 0.001). Conclusions: In this study, effective BP control was obtained with losartan and ramipril and LVH was found to be regressed significantly in the hypertensive patients with ADPKD. These two groups of antihypertensive drugs may also have beneficial effects on the retardation of renal progression and in reducing cardiovascular mortality in hypertensive patients with ADPKD.

A systematic review of the predictors of disease progression in patients with autosomal dominant polycystic kidney disease

“…Change in TKV was reported as a measure of disease progression in 12 studies (31.6 %), with 11 publications using magnetic resonance imaging (MRI) and one publication using computed tomography. Renal enlargement over time as a surrogate marker of disease progression was also measured by total cyst volume (TCV) (five studies) [ 14 – 18 ], volume of each kidney (four studies) [ 19 – 22 ], and total renal volume (TRV) (three studies) [ 19 , 22 , 23 ].…”

Left ventricular mass regression, all-cause and cardiovascular mortality in chronic kidney disease: a meta-analysis

“…This included 6 studies using ESAs to treat to a higher vs. lower hemoglobin target [ 37 , 38 , 43 – 46 ], 10 studies of RAASi vs. placebo or vs. another blood pressure-lowering agent [ 29 , 34 – 36 , 40 , 47 , 49 , 53 , 54 , 70 ], 14 studies of more intensive vs. less intensive hemodialysis (greater frequency or vs. high-flux hemodialysis or more intensive fluid management) [ 30 , 48 , 51 , 56 , 57 , 61 , 64 , 67 , 68 , 72 , 74 , 76 , 78 , 82 ], and 12 studies of other types of interventions [ 31 , 33 , 52 , 62 , 66 , 75 , 77 , 79 , 83 – 86 ]. A total of 30 studies enrolled predominantly ESKD patients (defined as patients on hemodialysis) [ 29 – 31 , 35 , 36 , 38 , 40 , 48 , 49 , 51 , 54 , 56 , 57 , 61 , 64 , 67 , 68 , 70 , 72 , 74 – 79 , 82 – 86 ] and 12 studies did not enroll patients on dialysis [ 33 , 34 , 37 , 43 – 47 , 52 , 53 ,…”

“…A total of 30 studies enrolled predominantly ESKD patients (defined as patients on hemodialysis) [ 29 – 31 , 35 , 36 , 38 , 40 , 48 , 49 , 51 , 54 , 56 , 57 , 61 , 64 , 67 , 68 , 70 , 72 , 74 – 79 , 82 – 86 ] and 12 studies did not enroll patients on dialysis [ 33 , 34 , 37 , 43 – 47 , 52 , 53 , 62 , 66 ].…”

Renal artery occlusion in autosomal dominant polycystic kidney disease

“…Physical examination showed the following data: height 164 cm, weight 89 kg, temperature 36. 3 C, pulse rate 65 beats/min and blood pressure 160/90 mmHg; examination of the fundi did not showed hemorrhages, exudates or papilledema.…”

“…Its pathogenesis is complex and dependent on many factors that influence each other. 3,4 We report a patient with ADPKD and left renal artery occlusion.…”