Effect of ramipril on glycosylated hemoglobin and liver function test in patients of diabetic nephropathy


  • Dharmender Gupta Department of Pharmacology, Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
  • N. A. Ansari Department of Pharmacology, Hind Institute of Medical Sciences, Safedabad, Lucknow, Uttar Pradesh, India
  • Kauser Sayedda Department of Pharmacology, Shri Ram Murti Smarak Institute of Medical Science, Bhojipura, Bareilly, Uttar Pradesh, India


Ramipril, Glycosylated hemoglobin, Liver function test, Diabetic nephropathy.


Background: Diabetic nephropathy (DN) is a chronic complication of diabetes mellitus with a growing incidence. Therefore, it is essential to have a better understanding of it, especially in relation to prevention and aggressive management to avoid progression to end-stage renal disease.

Methods: This prospective randomized study represented the effects of ramipril on glycosylated hemoglobin (HbA1c), liver function tests (LFT), mean arterial blood pressure, and serum potassium level in patients diagnosed with DN, with concomitant mild to moderate hypertension. 135 diagnosed patients with DN treated with ramipril 5 mg daily for 3 months were involved in this study. Blood samples were taken from all patients and analyzed for HbA1c, LFT including alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum alkaline phosphatase (ALP), and bilirubin with serum potassium level. After 3 months of treatment with ramipril (5 mg daily), blood samples were collected and analyzed again to determine the same parameters.

Results: Ramipril produced a significant reduction in (HbA1c) of hypertensive patients (p<0.05), whereas, serum levels of ALT, AST, ALP, and bilirubin were significantly elevated. The results indicated that ramipril may cause liver injury. Meanwhile, the mean arterial pressure was decreased significantly by ramipril (p<0.05).

Conclusion: The present study concluded that: ramipril significantly reduced the percentage of HbA1c but may cause liver injury, monitoring of liver enzymes is advisable for patients on ramipril.


Cheung B. Blockade of the renin-angiotensin system. Hong Kong Med J. 2002;8(3):185-91.

Diet F, Pratt RE, Berry GJ, Momose N, Gibbons GH, Dzau VJ. Increased accumulation of tissue ACE in human atherosclerotic coronary artery disease. Circulation. 1996;94(11):2756-67.

Fukuhara M, Geary RL, Diz DI, Gallagher PE, Wilson JA, Glazier SS, et al. Angiotensin-converting enzyme expression in human carotid artery atherosclerosis. Hypertension. 2000;35:353-9.

Sweitzer NK. Cardiology patient page. What is an angiotensin converting enzyme inhibitor? Circulation. 2003;108(3):e16 8.

Bennett PN, Brown MJ. Clinical Pharmacology. 9th Edition. Edinburgh: Churchill Livingstone; 2005: 467-9.

Neal L, Benowtiz MD. Cardiovascular-renal drugs-antihypertensive agents. In: Bertram G, Katzung BG, editors. Basic and Clinical Pharmacology. 9th Edition. New York: McGraw Hill Companies; 2004: 178.

Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342(3):145-53.

Leiter LA, Lewanczuk RZ. Of the renin-angiotensin system and reactive oxygen species Type 2 diabetes and angiotensin II inhibition. Am J Hypertens. 2005;18(1):121 8.

Vermes E, Ducharme A, Bourassa MG, Lessard M, White M, Tardif JC, et al. Enalapril reduces the incidence of diabetes in patients with chronic heart failure: insight from the Studies of Left Ventricular Dysfunction (SOLVD). Circulation. 2003;107(9):1291-6.

Ashton N. Perinatal development and adult blood pressure. Braz J Med Biol Res. 2000;33(7):731-40.

Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors. JAMA. 1995;274(7):538.

Ray K, Dorman S, Watson R. Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction. J Hum Hypertens. 1999;13(10):717-20.

Yeung E, Wong FS, Wanless IR, Shiota K, Guindi M, Joshi S, et al. Ramipril-associated hepatotoxicity. Arch Pathol Lab Med. 2003;127(11):1493-7.

Hagley MT, Benak RL, Hulisz DT. Suspected cross-reactivity of enalapril- and captopril-induced hepatotoxicity. Ann Pharmacother. 1992;26(6):780-1.

Hilburn RB, Bookstaver D, Whitlock WL. Comment: angiotension-converting enzyme inhibitor hepatotoxicity: further insights. Ann Pharmacother. 1993;27(9):1142-3.

Hagley MT, Hulisz DT, Burns CM. Hepatotoxicity associated with angiotensin-converting enzyme inhibitors. Ann Pharmacother. 1993;27(2):228-31.

Katzung BG. Basic & Clinical Pharmacology. 9th Edition. Stamford Conn: Appleton & Lange; 2004: 177-80.

Ekelund K, Johansson C, Nylander B. Effects of 16,16 dimethyl prostaglandin E2 on food-stimulated pancreatic secretion and output of bile in man. Scand J Gastroenterol. 1977;12(4):457-60.

Hagmann W, Denzlinger C, Keppler D. Role of peptide leukotrienes and their hepatobiliary elimination in endotoxin action. Circ Shock. 1984;14(4):223-35.

Pecoraro RE, Chen MS, Porte D Jr. Glycosylated hemoglobin and fasting plasma glucose in the assessment of outpatient glycemic control in NIDDM. Diabetes Care. 1982;5(6):592 9.

Padwal R, Majumdar SR, Johnson JA, Varney J, McAlister FA. A systematic review of drug therapy to delay or prevent type 2 diabetes. Diabetes Care. 2005;28(3):736-44.

Hansson L, Lindholm LH, Niskanen L, Lanke J, Hedner T, Niklason A, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet. 1999;353(9153):611-6.

DREAM trial investigators, Bosch J, Yusuf S, Gerstein HC, Pogue J, Sheridan P, et al. Effect of ramipril on the incidence of diabetes. N Engl J Med. 2006;355(15):1551-62.

Yusuf S, Gerstein H, Hoogwerf B, Pogue J, Bosch J, Wolffenbuttel BH, et al. Ramipril and the development of diabetes. JAMA. 2001;286(15):1882-5.

Scheen AJ. Prevention of type 2 diabetes mellitus through inhibition of the Renin-Angiotensin system. Drugs. 2004;64(22):2537-65.

Jandeleit-Dahm KA, Tikellis C, Reid CM, Johnston CI, Cooper ME. Why blockade of the renin-angiotensin system reduces the incidence of new-onset diabetes. J Hypertens. 2005;23(3):463-73.

Taylor EN, Hu FB, Curhan GC. Antihypertensive medications and the risk of incident type 2 diabetes. Diabetes Care. 2006;29(5):1065-70.

Veltmar A, Gohlke P, Unger T. From tissue angiotensin converting enzyme inhibition to antihypertensive effect. Am J Hypertens. 1991;4:263S-69.

Chemla D, Hébert JL, Zamani K, Coirault C, Lecarpentier Y. A new formula for estimating mean aortic pressure. Lancet. 1999;353(9158):1069-70.

Meaney E, Alva F, Moguel R, Meaney A, Alva J, Webel R. Formula and nomogram for the sphygmomanometric calculation of the mean arterial pressure. Heart. 2000;84(1):64.

Janke J, Engeli S, Gorzelniak K, Luft FC, Sharma AM. Mature adipocytes inhibit in vitro differentiation of human preadipocytes via angiotensin type 1 receptors. Diabetes. 2002;51(6):1699-707.

Gorzelniak K, Engeli S, Janke J, Luft FC, Sharma AM. Hormonal regulation of the human adipose-tissue renin-angiotensin system: relationship to obesity and hypertension. J Hypertens. 2002;20(5):965-73.

Sharma AM, Janke J, Gorzelniak K, Engeli S, Luft FC. Angiotensin blockade prevents type 2 diabetes by formation of fat cells. Hypertension. 2002;40(5):609-11.




How to Cite

Gupta, D., Ansari, N. A., & Sayedda, K. (2017). Effect of ramipril on glycosylated hemoglobin and liver function test in patients of diabetic nephropathy. International Journal of Basic & Clinical Pharmacology, 4(2), 312–316. Retrieved from https://www.ijbcp.com/index.php/ijbcp/article/view/918



Original Research Articles