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Refractory hypertension in childhood--efficacy of captopril therapy
M Yamagishi1, M Kaneko, K Chiba
1Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Insights
Captopril effectively treats refractory hypertension in children with complex conditions, including renal anomalies and moyamoya disease. This oral medication offers a valuable option for pediatric patients unresponsive to traditional therapies.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Pharmacology
Background:
- Advances in blood pressure measurement and age-specific norms have improved identification of elevated blood pressure in children.
- Essential hypertension in childhood can persist into adulthood, necessitating early detection and monitoring.
- Treatment for secondary hypertension in pediatric populations has seen significant advancements.
Observation:
- Captopril, an angiotensin-converting enzyme inhibitor, has been used since 1979 for severe pediatric hypertension unresponsive to standard treatments.
- Three cases are presented: a 2-year-old with renal/renovascular anomalies, a 7-year-old with moyamoya disease post-surgery, and a 17-year-old with Cushingoid syndrome.
- All three pediatric patients achieved good blood pressure control with captopril.
Findings:
- Captopril demonstrated efficacy in managing refractory hypertension across diverse pediatric conditions.
- Biochemical markers of the renin-angiotensin-aldosterone system showed expected changes primarily in the case with renal anomalies.
Implications:
- Captopril represents a crucial therapeutic option for pediatric patients with difficult-to-manage hypertension.
- Further research into the renin-angiotensin-aldosterone system's response to captopril in pediatric hypertension is warranted.
- Early identification and effective management of hypertension in childhood are vital for long-term health outcomes.
Abstract:
Because of the advance of techniques and age-matched apparatus for blood pressure measurement, and because of the availability of age-related normal values in childhood, the knowledge of the number of children having elevated blood pressures has recently improved. In a group of healthy children, the first important task is to determine how many incidences of "essential hypertension" there are among them, which may appear in childhood and persist into adulthood. This should urge us to undertake periodical examinations of healthy children. On the other hand, the treatment of "secondary hypertension" has similarly been improved. Since 1979 in particular, captopril, an orally active angiotensin I-converting enzyme inhibitor, has successfully been administered to treat children with malignant hypertension and who respond poorly to conventional antihypertensive therapies. We report 3 cases that received captopril for refractory hypertension: a 2-year-old boy with renal and renovascular anomalies, a 7-year-old boy with moyamoya disease after surgical operation, and a 17-year-old youth with Cushingoid syndrome due to chronic administration of steroids against mixed connective tissue disease. After the introduction of captopril, good pressure control was obtained in all 3 cases, although reasonable effects of measurement values of the renin-angiotensin-aldosterone system (decrease in angiotensin I & II, increase in I/II ratio, etc.) were found only in the first case.