Randomized, Double-Blind, Controlled Study of Losartan in Children with Proteinuria

Abstract

Results: Twelve weeks of treatment with losartan significantly reduced proteinuria compared with amlodipine/placebo: losartan ؊35.8% (95% confidence interval: ؊27.6% to ؊43.1%) versus amlodipine/placebo 1.4% (95% confidence interval: ؊10.3% to 14.5%), P < 0.001. Significance remained after adjustment for differences across treatment groups in change in BP (losartan produced incremental systolic and diastolic BP reductions versus amlodipine of 5.4 and 4.6 mmHg, respectively; and versus placebo of 3.8 and 4.0 mmHg, respectively). Proteinuria reduction was consistently observed in the normotensive (؊34.4% losartan; 2.6% placebo) and hypertensive (؊41.5% losartan; 2.4% amlodipine) strata, and in all prespecified subgroups, including age, gender, race, Tanner stage, weight, prior therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, as well as among the most common etiologies of proteinuria. Adverse event incidence was low and comparable in all groups.Conclusions: Losartan significantly lowered proteinuria and was well tolerated after 12 weeks in children aged 1 to 17 years with proteinuria with or without hypertension, a population that has not previously been rigorously studied.

Late Coarctation Presenters Suffer Chronic Hypertension Resisting to Medicine Treatment

“…Like ACE -i, ARBs is particularly beneficial in reducing LVH in adults with CHF. In adults and children, ARBs are effective at reducing proteinuria secondary to diabetes and may be particularly useful in patients with chronic kidney disease [41]. However, ARBs are generally less efficacious in African Americans.…”

Late Coarctation Presenters Suffer Chronic Hypertension Resisting to Medicine Treatment

“…From these, despite the historical use of propranolol and atenolol metoprolol is the only FDA approved b-blocker for pediatric HTN [38]. [40]. However, in a small crossover study of 18 adult patients, metoprolol was found to be more effective than candesartan at lowering systolic blood pressure [10].…”

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“…Previous studies have included prospective, doubleblind, randomized controlled trials that compared the use of losartan with enalapril and/or amlodipine in patients with chronic kidney disease or kidney transplant. 1,4,11,12,[22][23][24] However, randomized controlled trials may not be feasible in children for some conditions. In the present study, losartan was added during follow-up in patients who had hypertension and proteinuria that could not be controlled with enalapril alone or in combination with amlodipine.…”

“…These drugs are used commonly in adults, but there are concerns about the efficacy and safety of these drugs in children, in whom the causes of chronic kidney disease may be different than adults. 11,12 Losartan is a potent, orally active, and selective nonpeptide blocker of the angiotensin II type 1 receptor. Losartan reduces blood pressure, proteinuria, serum uric acid level, and hemoglobin level and may have positive effects on renal excretory function and posttransplant erythrocytosis in adult patients who have chronic kidney disease and who are kidney transplant recipients.…”

“…Losartan reduces blood pressure, proteinuria, serum uric acid level, and hemoglobin level and may have positive effects on renal excretory function and posttransplant erythrocytosis in adult patients who have chronic kidney disease and who are kidney transplant recipients. 1,3,4,8,[11][12][13][14] However, there is no previous study about the efficacy and tolerability of losartan or losartan and enalapril in pediatric kidney transplant recipients.…”