Andrew M South1,2, Lester Arguelles3, Gal Finer4,5, Craig B Langman4,5. 1. Section of Nephrology, Department of Pediatrics, Wake Forest School of Medicine, Brenner Children's Hospital, Winston Salem, NC, USA. asouth@wakehealth.edu. 2. Cardiovascular Sciences Center, Wake Forest School of Medicine, One Medical Center Boulevard, Winston Salem, NC, 27157, USA. asouth@wakehealth.edu. 3. School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, Chicago, IL, 60612, USA. 4. Division of Kidney Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 5. Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue #37, Chicago, IL, 60611, USA.
Abstract
BACKGROUND: Pediatric primary hypertension (HTN) is increasingly recognized, but the effect of patient characteristics such as obesity and race on treatment outcomes is not well described. The renin-angiotensin-aldosterone system (RAAS) may also contribute to HTN. We hypothesized patient parameters of these factors, including baseline RAAS, influence blood pressure (BP) response to pharmacological treatment in HTN. METHODS: This was a retrospective cohort of 102 consecutive patients with HTN. Primary outcomes were changes per year in systolic and diastolic BP (SBP, DBP). Secondary outcome was change per year in left ventricular mass index (LVMI). We evaluated whether baseline plasma renin activity (PRA), aldosterone, renin-to-aldosterone ratio, overweight/obesity, race, initial drug choice, and multidrug therapy were associated with the outcomes using general linear regression models adjusted for confounding variables. RESULTS: Racially diverse (43% Hispanic, 28% black, 25% white) and predominantly overweight/obese (75%) patients were studied. Median length of follow-up was 14.5 months. Higher baseline aldosterone was associated with decreased SBP (-1.03 mmHg/year), DBP (-0.95 mmHg/year), and DBP z score (-0.07/year) during the study period. Higher baseline PRA was associated with decreased SBP z score (-0.04/year) and LVMI (-2.89 g/m2.7/year). Stratified analyses revealed the relationships between baseline aldosterone and PRA, and annual reductions in outcomes were strengthened in nonobese and white patients. CONCLUSIONS: Pretreatment aldosterone and PRA predicted short-term follow-up BP and LVMI, especially in nonobese and white patients. The RAAS profile could guide treatment of HTN and suggests consideration of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers as first-line treatment options.
BACKGROUND: Pediatric primary hypertension (HTN) is increasingly recognized, but the effect of patient characteristics such as obesity and race on treatment outcomes is not well described. The renin-angiotensin-aldosterone system (RAAS) may also contribute to HTN. We hypothesized patient parameters of these factors, including baseline RAAS, influence blood pressure (BP) response to pharmacological treatment in HTN. METHODS: This was a retrospective cohort of 102 consecutive patients with HTN. Primary outcomes were changes per year in systolic and diastolic BP (SBP, DBP). Secondary outcome was change per year in left ventricular mass index (LVMI). We evaluated whether baseline plasma renin activity (PRA), aldosterone, renin-to-aldosterone ratio, overweight/obesity, race, initial drug choice, and multidrug therapy were associated with the outcomes using general linear regression models adjusted for confounding variables. RESULTS: Racially diverse (43% Hispanic, 28% black, 25% white) and predominantly overweight/obese (75%) patients were studied. Median length of follow-up was 14.5 months. Higher baseline aldosterone was associated with decreased SBP (-1.03 mmHg/year), DBP (-0.95 mmHg/year), and DBP z score (-0.07/year) during the study period. Higher baseline PRA was associated with decreased SBP z score (-0.04/year) and LVMI (-2.89 g/m2.7/year). Stratified analyses revealed the relationships between baseline aldosterone and PRA, and annual reductions in outcomes were strengthened in nonobese and white patients. CONCLUSIONS: Pretreatment aldosterone and PRA predicted short-term follow-up BP and LVMI, especially in nonobese and white patients. The RAAS profile could guide treatment of HTN and suggests consideration of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers as first-line treatment options.
Authors: Rebecca L Ruebner; Derek Ng; Mark Mitsnefes; Bethany J Foster; Kevin Meyers; Bradley Warady; Susan L Furth Journal: Clin J Am Soc Nephrol Date: 2016-09-14 Impact factor: 8.237
Authors: F Massiéra; M Bloch-Faure; D Ceiler; K Murakami; A Fukamizu; J M Gasc; A Quignard-Boulange; R Negrel; G Ailhaud; J Seydoux; P Meneton; M Teboul Journal: FASEB J Date: 2001-10-15 Impact factor: 5.191