Indikation
Blodtryckssänkning eller reduktion av proteinuri vid njursjukdom eller diabetes
Motivering
Välundersökt ACE-hämmare med renoprotektiva effekter och lågt pris. God samstämmighet med rekommendationerna för allmän hypertonibehandling.
Ramipril minskar progresstakten av njurinsufficiens och utvecklingen av njursvikt med behov av dialys eller njurtransplantation hos patienter med nedsatt njurfunktion och proteinuri. Hos hypertoniker med diabetes och begynnande nefropati reduceras albuminutsöndringen.
Utredningsmaterial och referenser
- Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138(17):e426-e83. PubMed
- Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. PubMed
- Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney inter., Suppl. 2012;2:337-414. KDIGO
- Läkemedelsverket. Information från Läkemedelsverket 2014:(25)5
- Lv J, Ehteshami P, Sarnak MJ, Tighiouart H, Jun M, Ninomiya T, et al. Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis. CMAJ. 2013: 185:949-57. PubMed
- Malhotra R, Nguyen HA, Benavente O, Mete M, Howard BV, Mant J, et al. Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(10):1498-1505. PubMed
- Ravid M, Brosh D, Levi Z, Bar-Dayan Y, Ravid D, Rachmani R. Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes. A randomized, controlled trial. Ann Intern Med 1998;128:982-8. PubMed
- Vekajama P, Thakkinstian A, Lertrattananon D, Ingsathit A, Ngarmukos C, Attia J. Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis. Diabetologia 2012;55(3):566-78. PubMed
- Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016 Jan 30;387(10017):435-43. PubMed
Bedömning utförd av
Expertrådet för medicinska njursjukdomar