Effects of angiotensin converting enzyme inhibitor: ramipril on different biochemical parameters in essential hypertensive patients

Pratibha S. Salve, Chitra C. Khanwelkar, Preeti S. Salve, Vandana M. Thorat, Somnath M. Matule


Background: Hypertension is a major risk factor for macrovascular diseases. The beneficial effects of lowering blood pressure on the vascular morbidity and mortality are well documented and demonstrated. The beneficial effects of antihypertensive agents on cardiovascular system can be counter-balanced by the induction of metabolic disorders. The modifications in various metabolic parameters (like lipids, serum electrolytes, uric acid, blood glucose levels, etc) are responsible for different adverse drug reactions of antihypertensive drugs. It might also have potential to produce secondary morbidities after long term use. The present study was designed to evaluate the effect of the commonly used first line antihypertensive drugs on these different biochemical parameters. Recent comparative studies suggest that, for the prevention of cardiovascular events, angiotensin converting enzyme inhibitor (ACEI) may be superior to alternative antihypertensive agents, independently of their antihypertensive effect and also claimed to have neutral or favourable effects on carbohydrate metabolism, lipid profile, uric acid. The metabolic abnormalities can be improved by ACEI. Therefore, this study was conducted to evaluate the effects of ramipril on different biochemical parameters in essential hypertensive patients. Objective was to study effects of six months monodrug therapy with ramipril on different biochemical parameters in essential hypertensive patients.

Methods: 30 newly diagnosed patients of either gender with essential hypertension were included in the study. Patients having co-morbidities like diabetes mellitus, hyperlipidemia, gout, pregnant females were excluded from the study. Baseline readings of lipid profile, serum electrolytes, fasting blood sugar and uric acid were recorded before starting ramipril drug therapy. Same biochemical tests were repeated after six months ramipril monodrug treatment.

Results: After comparing the means there is significant decrease in triglyceride levels, highly significant decrease in LDL, uric acid, sodium and fasting sugar level and highly significant increase in HDL levels.

Conclusions: Ramipril has beneficial effects on RAS (Renin angiotensin system) and kinin system or both may contribute to the improvement in different biochemical parameters by ramipril.


Biochemical parameters, Essential hypertension, Ramipril

Full Text:



Ezzati M, Lopez AD, Rodgers A, Hoorns V, Murray CJ. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347-60.

Kavgaci H, Sahin A, Onder Ersoz H, Erem C, Ozdemir F. The effects of losartan and fosinopril in hypertensive type 2 diabetic patients. Diabetes Res Clin Pract. 2002;58:19-25.

Lacourciere Y, Belanger A, Godin C, Halle JP, Ross S, Wright N, et al. Long term comparison of losartan and enelapril on kidney function in hypertensive type 2 diabetics with early nephropathy. Kidney Int. 2000;58:762-9.

Willis Al, Nagel B, Churchill V, Whyte MA, Smith DL, Mahmud I, et al. Antiatherosclerotic effects of nicardipine and nifedipine in cholesterol fed rabbits. Atherosclerosis. 1985;5:250-5.

Pollare T, Lithell H, Berne C. A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. N Engl J Med. 1989;321:868-73.

Derosa G, Cicero AF, Ciccarelli L, Fogari R. Perindopril and candesartan comparative efficacy and safety in type II diabetic hypertensive patients. J Hum Hypertens. 2003;17:433-5.

Mancini J, Gregory H, Macaya C, O'Neill BJ, Pucillo AL, Carere RG et al. Angiotensin-converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease. The TREND study. Circulation. 1996;94:258-65.

Schmidt A, Gruber U, Bohmig G, Koller E, Mayer G. The effect of ACE inhibitor and angiotensin II receptor antagonist therapy on serum uric acid levels and potassium homeostasis in hypertensive renal transplant recipients treated with CsA. Nephrol Dial Transplant. 2001;16:1034-7.

Weinberger MH. Influence of an angiotensin converting enzyme inhibitor on diuretic-induced metabolic effects in hypertension. Hypertension. 1983;5(5):132-8.

Reyes AJ. Cardiovascular drugs and serum uric acid. Cardiovasc Drugs Ther. 2003;17:397-414.

Selby JV, Friedman GD, Quesenberry CP. Precursors of essential hypertension: pulmonary function, heart rate, uric acid, serum cholesterol, and other serum chemistries. Am J Epidemiol. 1990;131:1017-27.

Jossa F, Farinaro E, Panico S, Krogh V, Celentano E, Galasso R, Mancini M, Trevisan M. Serum uric acid and hypertension: the Olivetti heart study. J Hum Hypertens. 1994;8:677-81.

Lithell H. Effect of antihypertensive drugs on insulin, glucose, and lipid metabolism. Diabetes Care. 1991;14:203-9.

Tomiyama H, Kushiro T, Abeta H, Ishii T, Takahashi A, Furukawa L, et al. Kinins contribute to the improvement of insulin sensitivity during treatment with angiotensin converting enzyme inhibitor. Hypertension. 1994;23:450-5.

Torlone E, Britta M, Rambotti AM, Perriello G, Santeusanio F, Brunetti P, et al. Improved insulin action and glycemic control after long-term angiotensin-converting enzyme inhibition in subjects with arterial hypertension and type II diabetes. Diabetes Care. 1993;16:1347-55.

Vuorinen-Markkola H, Yki-Jarvinen H. Antihypertensive therapy with enalapril improves glucose storage and insulin sensitivity in hypertensive patients with non-insulin-dependent diabetes mellitus. Metabolism. 1995;44:85-9.

Fogari R, Zoppi A, Malamani GD, Marasi G, Vanasia A, Villa G. Effects of different antihypertensive drugs on plasma fibrinogen in hypertensive patients. Br J Clin Pharmacol. 1995;39:471-6.

Reardon LC, Macpherson DS. Hyperkalemia in outpatients using angiotensin-converting enzyme inhibitors. How much should we worry? Arch Intern Med. 1998;158:26-32.