Angiotensin converting enzyme inhibitor therapy to decrease microalbuminuria in normotensive children with insulin-dependent diabetes mellitus

Care of Children and Adolescents With Type 1 Diabetes

“…Some data suggest that lowering LDL cholesterol may also provide benefit (133). Even in the absence of hypertension, therapy with an ACE inhibitor reverses increased albumin excretion or delays the rate of progression to macroalbuminuria (135)(136)(137). Screening provides an opportunity to detect microalbuminuria early, to initiate ACE inhibition therapy, and to encourage meticulous attention to achieving glycemic goals during the reversible phase of diabetic nephropathy.…”

“…There is good evidence that ACE inhibitor treatment of hypertension decreases the rate of decline of renal function in adults (134,135). Decrease in AERs independent of their antihypertensive effects has been described with the use of enalapril and captopril in adolescents, and there have been no reports of significant side effects (135)(136)(137). Furthermore, use of ACE inhibitors in adults decreases progression of retinopathy (145) and cardiovascular disease (146).…”

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

“…They suggest that ACE inhibitors or ARBs should be considered the first-line antihypertensive medications to slow the rate of progression of renal disease, although note that the supporting evidence is weak [15]. Four small nonrandomized trials showed that ACE inhibitors or ARBs could reduce proteinuria in children with renal disease [32][33][34][35]. The studies were uncontrolled except for one small placebo cross-over study [33].…”

“…Four small nonrandomized trials showed that ACE inhibitors or ARBs could reduce proteinuria in children with renal disease [32][33][34][35]. The studies were uncontrolled except for one small placebo cross-over study [33]. However, the Work Group cautions against the use of ACE inhibitors in neonates owing to the increased risk of side effects and in premature infants because of the importance of the renin-angiotensin system in normal renal development [36][37][38].…”

Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes

“…Furthermore, indirect support for our findings could be inferred from recent clinical trials, which demonstrated the renoprotective effect of ACE inhibitors on diabetic patients with normal clinically measured BP. [41][42][43][44][45][46] For example, in one such study, Viberti et al 41 reported that among normotensive type 1 diabetes patients, treatment with captopril reduced albuminuria but was also accompanied by a significant reduction in mean BP. It is possible that at least part of this reduction in albumin excretion among normotensive patients was mediated through the effect of captopril on BP.…”