Efficacy and safety of angiotensin II receptor type 1 antagonists in children and adolescents

Herder, Siegtraut Dorothea; Weber, Ernst; Winkemann, Almuth; Herder, Christoph F.; Morck, Hartmut

doi:10.1007/s00467-009-1346-z

Cited by 16 publications

(12 citation statements)

References 59 publications

(124 reference statements)

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“…As reported by other authors [40], enalapril and losartan were well tolerated, similar to the experience reported in hypertensive otherwise healthy preschool and school children [41].…”

Section: Discussionsupporting

confidence: 88%

Effect of diet, enalapril, or losartan in post-diarrheal hemolytic uremic syndrome nephropathy

et al. 2011

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Proteinuria is the main indicator of renal disease progression in many chronic conditions. There is currently little information available on the efficacy, safety, and individual tolerance of patients with post-diarrheal hemolytic uremic syndrome (D+ HUS) nephropathy to therapies involving diet, enalapril, or losartan. A multicenter, double-blind, randomized controlled trail was conducted to evaluate the effect of a normosodic-normoproteic diet (Phase I) and the effect of normosodic-normoproteic diet plus enalapril (0.18-0.27 mg/kg/day) or losartan (0.89-1.34 mg/kg/day) (Phase II) on children with D+ HUS, normal renal function, and persistent, mild (5.1-49.9 mg/kg/day) proteinuria. Dietary intervention reduced the mean protein intake from 3.4 to 2.2 mg/kg/day. Of 137 children, proteinuria normalized in 91 (66.4 %) within 23-45 days; the remaining 46 patients were randomized to diet plus placebo (group 1, n = 16), plus losartan (group 2, n = 16), or enalapril (group 3, n = 14). In groups 1, 2, and 3, proteinuria was reduced by 30.0, 82.0, and 66.3%, respectively, and normalized in six (37.5%), three (81.3%), and 11 (78.6%) patients, respectively (χ(2)= 8.9, p = 0.015). These results suggest that: (1) a normosodic-normoproteic diet can normalize proteinuria in the majority of children with D+ HUS with mild sequelae, (2) the addition of enalapril or losartan to such dietary restrictions of protein further reduces proteinuria, and (3) these therapeutic interventions are safe and well tolerated. Whether these short-term effects can be extended to the long-term remains to be demonstrated.

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“…As reported by other authors [40], enalapril and losartan were well tolerated, similar to the experience reported in hypertensive otherwise healthy preschool and school children [41].…”

Section: Discussionsupporting

confidence: 88%

Effect of diet, enalapril, or losartan in post-diarrheal hemolytic uremic syndrome nephropathy

et al. 2011

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“…Similar congenital malformations seen with ACEI exposure during pregnancy have been reported 32. Studies involving candesartan, losartan, and valsartan showed no effect on growth during study periods of 52 weeks for each 32,34…”

Section: Clinical Studies Safety and Efficacysupporting

confidence: 67%

“…Losartan reduced DBP in a dose dependent fashion at doses from 0.75 mg/kg/day to 1.44 mg/kg/day and was well tolerated. A small irbesartan study indicated that doses of 75–150 mg/day were efficacious in the treatment of hypertension but a later study in children ages 6–16 years failed to show a significant antihypertensive effect 5,12,32. In the Assessment of Efficacy and Safety of Olmesartan in Pediatric Hypertension (AESOP) study, two groups of children ages 6–16 years of age were enrolled and given either low-dose (2.5–5 mg) or high dose (20–40 mg) Olmesartan daily for three weeks.…”

Section: Clinical Studies Safety and Efficacymentioning

confidence: 99%

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Therapeutic Options for the Treatment of Hypertension in Children and Adolescents

Stephens¹,

Fox

Maxwell³

2012

Clin Med Insights Circ Respir Pulm Med

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Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%–5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies.

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“…They are also recommended for children 1–4. These drugs are generally felt to have very favourable side-effect profiles in adults1 and children 3. Some authors have even stated that the side effects are similar to those of placebo 5…”

Section: Introductionmentioning

confidence: 99%

Safety Concerns of Angiotensin II Receptor Blockers in Preschool Children

Tullus

2011

Archives of Disease in Childhood

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Two recent trials of angiotensin II receptor blockers (ARBs) were performed in children 0-5 years of age. Data from the published reports of these trials together with additional information from the sponsoring drug companies were obtained. Three deaths occurred in the 183 (1.6%) hypertensive children participating in the two trials. At least two of these deaths occurred in children known to be susceptible to drugs acting on the renin-angiotensin system, that is, children with ongoing nephrotic syndrome and acute gastroenteritis. Clinicians who prescribe ARBs in preschool children need to be aware of the risk of drug toxicity especially in children susceptible to intravascular dehydration. Clinicians should consider discontinuing the drugs in the presence of acute diarrhoea.

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Efficacy and safety of angiotensin II receptor type 1 antagonists in children and adolescents

Cited by 16 publications

References 59 publications

Effect of diet, enalapril, or losartan in post-diarrheal hemolytic uremic syndrome nephropathy

Effect of diet, enalapril, or losartan in post-diarrheal hemolytic uremic syndrome nephropathy

Therapeutic Options for the Treatment of Hypertension in Children and Adolescents

Safety Concerns of Angiotensin II Receptor Blockers in Preschool Children

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