Regression of Left-Ventricular Hypertrophy in Children and Adolescents With Hypertension During Ramipril Monotherapy

Background Left-ventricular hypertrophy (LVH) is a risk factor for cardiovascular morbidity. Antihypertensive treatment with angiotensin-converting enzyme inhibitors (ACEI) is able to induce the regression of LVH in adults. However, there has been no study of the ability of ACEI to induce the regression of LVH in children. Our aim was to investigate the effect of ramipril on left-ventricular mass and blood pressure (BP) in hypertensive children. Methods Twenty-one children (median age, 15 years) with renal (76%) or primary (24%) hypertension were prospectively treated with ramipril monotherapy for 6 months. Blood pressure was evaluated using ambulatory BP monitoring, with hypertension defined as mean BP ≥95th percentile. Left-ventricular hypertrophy was defined either as left-ventricular mass index (LVMI) >38.6 g/m2.7 (pediatric definition) or as LVMI >51.0 g/m2.7 (adult definition). Results Nineteen children completed the study. The median LVMI decreased from 36.8 g/m2.7 (range, 18.9 to 55.8 g/m2.7) to 32.6 g/m2.7 (range, 19.0 to 52.1 g/m2.7; P< .05) after 6 months. The prevalence of LVH decreased from 42% to 11% using the pediatric definition (P< .05) and did not change using the adult definition (ie, it remained at 5%). The median ambulatory BP decreased by 11, 7, 8, and 7 mm Hg for daytime systolic, daytime diastolic, nighttime systolic, and nighttime diastolic BP (P< .05), respectively. A positive correlation was found between LVMI and nighttime systolic BP at the start of the study (r = 0.46, P< .05). Conclusions Ramipril is an effective drug in children with hypertension, for its ability to reduce not only BP but also left-ventricular mass and induce regression of LVH.