Antihypertensive treatment prescription in pediatric dialysis patients in Poland: A comparison between two nationwide studies 2003/2004–2013

Wróblewski, Krzysztof; Hincz, Karolina; Miklaszewska, Monika; Zachwieja, Katarzyna; Wierciński, Ryszard; Stankiewicz, R; Firszt-Adamczyk, Agnieszka; Zachwieja, Jacek; Borzęcka, Halina; Ziółkowska, Helena; Medyńska, Anna; Zwołińska, Danuta; Szczepańska, Maria; Stańczyk, Małgorzata; Zagożdżon, Ilona; Leszczyńska, Beata; Świętochowska, Elżbieta; Tkaczyk, Marcin

doi:10.17219/acem/65823

Cited by 2 publications

(3 citation statements)

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“…We selected for this trial specifically ramipril as an ACE inhibitor because its long-term safety, despite some concerns, 44,45 was documented in children and the possibility of once daily treatment ensures better adherence. 22 A significant increase in serum potassium was observed in both the ramipril and the placebo group in the current trial, with no symptoms of severe hyperkalemia and no need for study withdrawal of any patient in either treatment arm. Dry cough, a frequent side effect of ACE inhibitors in adults, was reported in only one child in the ramipril group (1.5%).…”

Section: Discussionmentioning

confidence: 50%

“…The dose of ramipril was chosen based on previous studies conducted in pediatric hypertensive patients. 22…”

Section: Methodsmentioning

confidence: 99%

“…The dose of ramipril was chosen based on previous studies conducted in pediatric hypertensive patients. 22 The primary end point of the study was the effect of ramipril on endothelial dysfunction, as assessed by change in serum concentrations of ADMA and its effect on inflammation, as assessed by change in serum concentrations of hs-CRP (highsensitivity C-reactive protein). Secondary efficacy end points comprised the effect of ramipril on IL-6 (interleukin-6) and TNF-α, and the change in systolic blood pressure (SBP), DBP, and heart rate.…”

Section: What Is Relevant?mentioning

confidence: 99%

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Effects of Ramipril on Biomarkers of Endothelial Dysfunction and Inflammation in Hypertensive Children on Maintenance Hemodialysis: the SEARCH Randomized Placebo-Controlled Trial

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 50%

“…The dose of ramipril was chosen based on previous studies conducted in pediatric hypertensive patients. 22…”

Section: Methodsmentioning

confidence: 99%

Section: What Is Relevant?mentioning

confidence: 99%

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