Real-world Evidence of Lisinopril in Pediatric Hypertension and Nephroprotective Management: a 10-year Cohort Study

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2024 Oct 28

PMID 39466390

Authors

Eva Degraeuwe

Elke Gasthuys

Evelien Snauwaert

Lien Dossche

Agnieszka Prytula

Joke Dehoorne

An Vermeulen

Johan Vande Walle

Ann Raes

Affiliations

Soon will be listed here.

Abstract

Background: Over the last 20 years, pediatric hypertension (pHTN) prevalence in Western society has risen from 3.5 to 9% due to childhood overweight, obesity, and secondary kidney and cardiological conditions. Few studies have assessed commonly used antihypertensive medication lisinopril's (ACE-inhibitor) long-term efficacy and the long-term value of renin-angiotensin-aldosterone system (RAAS) biomarkers.

Methods: This is a retrospective cohort study at Ghent University Hospital, Belgium, with 106 young patients (1-18 years) treated with lisinopril due to hypertension (HTN) and chronic kidney disease (CKD) assessed for treatment outcomes against clinical benchmarks over 10 years.

Results: Lisinopril was mainly initiated for secondary hypertension or nephroprotection (89%) due to kidney causes. A starting dose across groups was lower than 0.07 mg/kg for 48% (n = 50). HTN patients without CKD achieved systolic blood pressure below the 95th percentile within 2 years, but efficacy declined after 2.5 years. CKD patients maintained a steady response, reaching systolic targets by 40 months and showing improved diastolic control over 70 months. Proteinuria reduction had a median urine protein creatinine ratio (UPCR) to 0.57 g/g at 6 months, with a reappearance of UPCR 2 g/g creatinine after 40 months. Aldosterone breakthrough occurred from 6 months onward in all groups. Over 70 months, aldosterone and aldosterone-renin-ratio (ARR) progression significantly differ between children with and without normal kidney function.

Conclusions: Treatment efficacy for systolic blood pressure in hypertensive patients with abnormal kidney function diminishes after 2.5 years and for proteinuria in children after 3 years, highlighting the need for dosage recalibration according to guidelines and/or the need for alternative treatments.

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