Antihypertensive drug therapy with captopril in children and adolescents

Captopril was administered to three groups of hypertensive children and adolescents: patients with renal disease; neonates with umbilical artery related hypertension; and post-renal transplant patients. In older children with renal disease, increasing the captopril dose above 0.5 mg/kg did not improve the antihypertensive response. A maximal drug concentrations occurred one hour after dosing, and captopril concentration returned to predose levels by eight hours. Neonates responded to significantly lower doses of captopril (0.01-0.5 mg/kg) and the duration of response to higher doses appeared to be longer than that observed in older children. In post-renal transplant patients, blood pressure decreased after captopril in 94% of subjects, but in 62% a concomitant increase in serum creatinine was observed (correlation [r] = 0.55, p less than .02). This increase could not be correlated with renal biopsy histopathology. Thus, captopril has proven to be an effective antihypertensive agent in children over a broad age range and for a variety of clinical conditions.