effect of ramipril on ambulatory blood pressure and albuminuria in renal hypertension inhibition of the angiotensinconverting enzyme ace exerts a renoprotective effect in adult patients with chronic kidney disease we evaluated prospectively changes in blood pressure bp protein excretion and renal function after administration of the longacting ace inhibitor ramipril as monotherapy during 6 months in 14 moderately hypertensive children aged 518 years with various nephropathies four patients initially had a decreased glomerular filtration rate gfr below 60 mlmin173 m2 bp was evaluated by ambulatory 24h monitoring after 2 weeks of treatment by oral ramipril 15 mgm2 once daily mean values of systolic and diastolic 24h ambulatory bp fell by more than 5 mmhg in nine patients in eight patients the dose was doubled at the end of the study systolic bp was below the 95th percentile in 9 and diastolic bp in 13 patients the initially reduced nocturnal dip increased significantly of 11 patients with an increased albumin excretion median 13 gg creatinine 6 responded to ramipril by a median reduction of 78 range 2483 whilst in 5 albuminuria increased median 19 gfr was well preserved and no other adverse effects from the drug were noted the study demonstrates that ramipril is an efficacious antihypertensive agent in children with renal hypertension it is well tolerated even in mild renal insufficiency in addition the drug has a persistent antiproteinuric action in about half of the patients contributing to conserve renal function