{"id":"39755a06c156","type":"article","url":"https://hartvaat.nl/2022/08/01/ramipril-bij-hypertensieve-kinderen-op-hemodialyse-search-trial/","title":"Ramipril bij hypertensieve kinderen op hemodialyse: SEARCH-trial","title_en":"Effects of Ramipril on Biomarkers of Endothelial Dysfunction and Inflammation in Hypertensive Children on Maintenance Hemodialysis: the SEARCH Randomized Placebo-Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":["aprocitentan","bloeddrukbehandeling","figaro-dkd","precision-trial","radiance-htn","ramipril","sacubitril-valsartan","select-trial","soul-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19312","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19312","authors":["Areej Mohamed Ateya","Ihab El Hakim","Sara Mahmoud Shahin","Radwa El Borolossy","Reinhold Kreutz","Nagwa Ali Sabri"],"significance":6,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"The SEARCH trial showed that ramipril improves endothelial dysfunction and inflammation biomarkers in hypertensive children on hemodialysis, supporting RAAS inhibition for vascular protection in the pediatric renal population.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De SEARCH-trial onderzocht het effect van ramipril op endotheeldysfunctie en inflammatiemarkers bij hypertensieve kinderen op hemodialyse. ACE-remming verbeterde de endotheelfunctie, wat het cardiovasculaire risico bij deze kwetsbare populatie kan verlagen.","abstract_original":"BACKGROUND: Hypertension, endothelial dysfunction, and inflammation are associated with increased cardiovascular mortality in end-stage kidney disease. We evaluated the effects of ACE (angiotensin-converting enzyme) inhibition on biomarkers of endothelial dysfunction and inflammation in hypertensive children with end-stage kidney disease on maintenance hemodialysis. METHODS: In a randomized, double-blind, placebo-controlled trial, 135 (72 males/63 females) children and adolescents (age 7-15 years) were randomly assigned to treatment with either 2.5 mg once daily ramipril (n=68) or placebo (n=67) for 16 weeks. Primary outcome were the serum concentrations of asymmetrical dimethylarginine, a marker of endothelial dysfunction and hs-CRP (high-sensitivity C-reactive protein), a marker of inflammation. Changes in IL-6 (interleukin-6), TNF-α (tumor necrosis factor-alpha), systolic (S), and diastolic (D) blood pressure were secondary outcomes. Change in potassium levels and incidence of hyperkalemia were among the safety parameters. RESULTS: Ramipril, but not placebo, significantly reduced serum levels of asymmetrical dimethylarginine (-79.6%; P<0.001), hs-CRP (-46.5%; P<0.001), IL-6 (-27.1%; P<0.001), and TNF-α (-51.7%; P<0.001). Systolic blood pressure and diastolic blood pressure were significantly lowered in both groups with a greater reduction in children receiving ramipril (median between-group differences -12.0 [95% CI -18.0 to -9.5] and -9.0 [95% CI -12.0 to -4.5]; P<0.001, respectively). Changes in asymmetrical dimethylarginine, hs-CRP, IL-6, or TNF-α in the ramipril group did not significantly correlate with blood pressure reductions. No severe cases of hyperkalemia or other serious treatment-associated adverse events were observed. CONCLUSIONS: Ramipril improves biomarkers of endothelial dysfunction and inflammation in hypertensive children on maintenance hemodialysis in addition to its efficacious and safe potential to lower blood pressure. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04582097."}