Renal and Cardiovascular Effects of Angiotensin-Converting Enzyme Inhibitor Plus Angiotensin II Receptor Antagonist Therapy in Children With Proteinuria

Abstract

In the short term, the combination of angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists for children with proteinuria of renal origin reduced proteinuria significantly, compared with baseline or either drug alone. Furthermore, echocardiographic studies gave evidence of reduction of left ventricular hypertrophy. Additional studies are needed to evaluate long-term results.

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease

“…A small randomized double blind cross-over trial in children with proteinuric renal disease demonstrated a similar reduction in proteinuria with ACE inhibitor compared with ARB, a finding that has been confirmed with a more recent larger trial [46,47]. Combined use of ACE inhibitors and ARBs has shown additional reduction in proteinuria with both agents in two small studies in children [48,49]. The KDIGO authors caution that risks of renin-angiotensin system blockers include hypotension in susceptible individuals, hyperkalemia, acute kidney injury during dehydrating illness, and teratogenicity if pregnancy occurs [16].…”

2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

“…If multiple drug therapy is required, diuretics and calcium channel blockers are the most suitable addition to a RAS blocker . Whereas the combined administration of ACE inhibitors, ARBs and the renin inhibitor aliskiren exert additional antiproteinuric effects in adults and children (233,234), it is recommended not to use such combination therapies because of increased rates of serious adverse events such as acute kidney injury and hyperkalemia observed in large randomized trials of high-risk adult patients (219-221).…”

Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension

“…If multiple drug therapy is required, diuretics and calcium channel blockers are the most suitable options. ARBs in combination with ACEIs have been suggested to have additional antiproteinuric and renoprotective effects [147], and a very small short-term study has also been done in children [148]. However, the negative results recently reported in the high-risk adult patients of ONTARGET [149] for the combination of the blockers of the renin-angiotensin system call for caution in the use of this combination at all ages.…”