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The captopril test in children with renovascular and renal hypertension
E Fossali1, R Intermite, M Minoja
1Clinica pediatrica II, Università di Milano, Italy.
Insights
The captopril test (CT) effectively identifies renin-angiotensin system activation (RASA) in children with renovascular hypertension (RVH). This diagnostic tool aids in demonstrating RASA, crucial for managing RVH in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Hypertension Research
- Endocrinology
Background:
- Renovascular hypertension (RVH) in children involves activation of the renin-angiotensin system (RASA).
- Accurate diagnosis of RASA is critical for effective management of pediatric hypertension.
- The captopril test (CT) is a potential diagnostic tool for assessing RASA.
Purpose of the Study:
- To evaluate the utility of the captopril test (CT) in diagnosing renin-angiotensin system activation (RASA) in children.
- To assess the diagnostic performance of CT in differentiating renovascular hypertension (RVH) from other forms of hypertension in pediatric patients.
Main Methods:
- The captopril test (CT) was administered to 32 children, including 8 with confirmed renovascular hypertension (RVH).
- Plasma renin activity (PRA) was measured before and after captopril administration.
- Diagnostic criteria for a positive CT included specific thresholds for post-captopril PRA and PRA increase.
Main Results:
- All 8 children with renovascular hypertension (RVH) exhibited a positive captopril test (CT).
- Positive CT results were characterized by elevated post-captopril plasma renin activity (PRA) and significant PRA increases.
- The CT demonstrated high sensitivity in detecting RASA in pediatric RVH cases.
Conclusions:
- The captopril test (CT) is a valuable tool for demonstrating renin-angiotensin system activation (RASA) in children with renovascular hypertension (RVH).
- CT can aid in the etiological diagnosis of hypertension in pediatric populations.
- Further studies may validate CT's role in routine pediatric hypertension workup.
Abstract:
We used the captopril test (CT) in 32 children, 8 with renovascular hypertension (RVH), 17 with renal hypertension (RH) and 7 with normal blood pressure, in order to study the renin-angiotensin system activation (RASA). All children affected by RVH presented a positive CT: a post-captopril plasma renin activity (PRA) of 12 ng ml-1 h-1 or more, an absolute PRA increase of 10 ng ml-1 h-1 or more and a 150% increase or more, or 400% or more if the baseline PRA was less than 3 ng ml-1 h-1. The CT may be useful for demonstrating the RASA in RVH.