Renal and cardiovascular effects of angiotensin-converting enzyme inhibitor plus angiotensin II receptor antagonist therapy in children with proteinuria

OBJECTIVE. We investigated whether the combination of an angiotensin-converting enzyme inhibitor and an angiotensin II type 1 receptor antagonist offers better control of proteinuria and cardiovascular parameters without causing adverse side effects. METHODS. We enrolled 10 children (mean age: 12.3 ± 4.06 years) with proteinuria resulting from chronic renal diseases of various causes. The study consisted of 2 phases, 3 months each, for an overall 6-month observation time. During phase 1 (3 months), each child was assigned randomly to treatment with either an angiotensin-converting enzyme inhibitor or an angiotensin II type 1 receptor antagonist alone. During phase 2, each child was advanced to combination therapy with the addition of an angiotensin II type 1 receptor antagonist or an angiotensin-converting enzyme inhibitor, respectively. Renal function tests, echocardiography, and 24-hour ambulatory blood pressure monitoring were performed at the beginning of the study (time 0), at 3 months (time 1), and at 6 months (time 2). RESULTS. At time 2, proteinuria (change: -80.21 ± 10.75%), interventricular septum index (change: -13.63 ± 18.64%), posterior wall of the left ventricle index (change: -30.71 ± 20.32%), and left ventricular mass index (change: -28.33 ± 24.44%) were reduced significantly, compared with time 0 and time 1. No untoward side effects were detected during the study. CONCLUSIONS. In the short term, the combination of angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists for children with proteinuria of renal origin reduced proteinuria significantly, compared with baseline or either drug alone. Furthermore, echocardiographic studies gave evidence of reduction of left ventricular hypertrophy. Additional studies are needed to evaluate long-term results. KEYWORDS. chronic kidney disease, proteinuria, left ventricular hypertrophy, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonist.