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Órgano Oficial del Instituto Nacional de Pediatría

2012, Number 2

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Acta Pediatr Mex 2012; 33 (2)

Arterial hypertension in pediatrics. Treatment based on its pathophysiology

Zaltzman-Girsevich S, Miranda-Ricardi E, Murata C, García-de la Puente S, Espino-Vela J

Language: Spanish
References: 47
Page: 64-70
PDF size: 386.09 Kb.


ABSTRACT

Background. The treatment of arterial hypertension (AHT) based on the rennin level (Renin-Guided Treatment of Hypertension RGTH) is a valuable algorithm based on the physiological subtypes of this condition. Some authors suggest that the rennin level test should be included routinely as a useful guide for the treatment of AHT. However there is no information of its efficacy in pediatric practice.
Objective. Obtain retrospective information to decide whether a prospective study is justified in order to determine the efficacy of the above algorithm in children with AHT.
Material and method. A study of a comparative historic cohort based on the charts of hypertensive children studied at the Instituto Nacional de Pediatría (INP) was done. We recorded and compared the time required to normalize blood pressure in two groups of patients: one group (study Group) was treated following the RGHT algorithm. Another group (control Group) was treated with the conventional method. Variables influencing the time for control of AHT were recorded.
Results. There were 39 patients in the Study Group and 43 in the Control Group. Both groups were similar in age, and in systolic and diastolic arterial blood pressure. The time median to normalize arterial blood pressure in the Study Group was 44 hours (CS 95%: 40-50 hours) For the Control Group it was 89 hours (CS 95%: 72-82 hours). This difference was highly significant (Log-Rank: P = 0.0008).
Conclusions. A prospective study to determine the efficacy of RGHT algorithm in hypertensive children is justified.


REFERENCES

  1. García S, Zaltzman S. Hipertensión arterial en niños. Acta Pediatr Mex 1994;15:233-48.

  2. Moragrega JL, Mendoza A. Cifras de tensión arterial en la infancia y la adolescencia en México. Arch Inst Cardiol Mex 1981;15:179-83.

  3. Guyton A, Hall J. Compendio de fisiología médica. 11ª Ed. España: Elsevier; 2007.

  4. Brenner BM. El riñón: Tratado de nefrología. 7ª Ed. España: Elsevier Saunders; 2004.

  5. Lande MB, Flynn JT. Treatment of hypertension in children and adolescents. Pediatr Nephrol 2009;10:1939-49.

  6. Hernández Avendaño L. Nefrología clínica. 3ª Ed. España: Médica Panamericana; 2009.

  7. Barratt MT. Pediatric nephrology. 4th Ed. USA: Williams & Wilkins; 1999.

  8. Ingelfinger JR. Pediatric hypertension. Curr Op Ped 1994;6:198-205.

  9. Lurbe E, Chaves FJ, Torró I, Armengod ME, Alvarez V, Redon J. Remediable glucocorticoid hyperaldosteronism: molecular diagnosis. Med Clin (Barc) 1999;113(15):579-82.

  10. Avner ED, Harmon WE, Niaudet P, Yoshikawa N. Pediatric nephrology. 6th Ed. USA: Lippincott Williams & Wilkins; 2009.

  11. Mitsnefes MM. Hypertension in children and adolescents. Pediatr Clin North Am 2006;53:493-512.

  12. Charra B, Chazot C. Volume control, blood pressure and cardiovascular function. Nephron Phisiol 2003;93:94-101.

  13. Poulter N, Hughes AD, Williams B, Brady AJ, McInnes G, British Hypertension Society. Angiotensin-converting enzyme inhibitors verus angiotensin receptor blockers. A mini-symposium held at the British Hypertension Society Meeting. September 2005. J Renin Angiotensin Aldosterone Syst 2006;7:104-21.

  14. Case DB, Wallace JM, Keim HJ. Possible role of renin in hypertension as suggested by rennin-sodium profiling and inhibition of converting enzyme. N Engl J Med 1977;296(12):641-6.

  15. Selkurt EE, Womack I, Dailey WN. Mechanism of natriuresis and diuresis during elevated renal arterial pressure. Am J Physiol 1965;209:95-9.

  16. Laragh JH, Brenner BM. Hypertension: Pathophysiology, diagnosis and management. 2nd Ed. New York: Raven Press; 1995. p. 1311-26.

  17. Dahl LK. Memorial lecture. The rennin system and four lines of hypertension research. Hypertension 1992, 20:267-79.

  18. Gordon D. The role of rennin substrate in hypertension. Hypertension 1983;5:353-62.

  19. Harrap SB, Cumming AD, Davies DL, Joy CJ, Frasser R, Kamitani A, et al. Glomerular hyperfiltration, high rennin, and low-extracellular volume in high blood pressure. Hypertension 2000;35:952-7.

  20. Cody RJ, Covit AB. Sodium and water balance in chronic congestive heart failure. J Clin Invest 1986;77:1441-52.

  21. Sinaiko AR. Practical pediatric nephrology. Treatment of hypertension in children. Peditar Nephrol 1994;8:603-9.

  22. Vetter H, Vetter W, Warnholz C, Bayer JM, Käser H, Vielhaber K, Krück F. Renin and aldosterone secretion in pheochromocytoma. Effect of chronic alpha-adrenergic receptor blockade. Am J Med 1976;60:866-71.

  23. Lagomarcino E. Tratamiento farmacológico de la hipertensión arterial en pediatría. Rev Chil Pediatr 2000;71:1-14.

  24. Flynn JT, Daniels SR. Pharmacologic treatment of hypertension in children and adolescents. J Pediatr 2006;149:746-54.

  25. Scheinman JI, Crevi DL, Narla LD, Chan JC. Asymptomatic childhood hypertension. Nephron 1998;79:131-6.

  26. Esler MD, Nestel PJ. High catecholamine essential hypertension: clinical and physiological characteristics. Aust N Z J Med 1973;3:117-23.

  27. Nguyen M, Mitsnefes M. Evaluation of hypertension by the general pediatrician. Curr Opin Pediatr 2007;19:165-9.

  28. Salgado CM, Abreu Carvalhaes JT. Arterial hypertension in childhood. J Pediatr 2003;1:S115-S24.

  29. Marcun ND, Gregoric A. A diagnostic approach for the child with hypertension. Pediatr Nephrol 2005;20:499-506.

  30. Ferro A, Pitt B. Renin inhibitors: An important advance in hypertension treatment? Int J Clin Pract 2006;60:1336-7.

  31. Soltero I, Isong Y, Cooper R, Stamler J, Stamler R. A survey of patterns of nonpharmacologic care for hypertensive patients, including recommendations for their children. Hypertension 1980;2:215-20.

  32. Buhler FR, Laragh JH. Propranolol inhibition of rennin secretion. A specific approach to diagnosis and treatment of rennin-dependent hypertensive diseases. N Engl J Med 1972;287;1209-14.

  33. Luma GB, Spiotta RT. Hypertension in children and adolescents. Am Fam Physician 2006;73:1558-68.

  34. Barret AM, Carter J. Comparative chronotropic activity of betaadrenoceptive antagonists. Br J Pharmacol 1970;40:373-81.

  35. Souza-Barbosa LA, Ferreira-Melo SE, Ubaid-Girioli S, Arantos Nogueira E, Yugar-Toledo JC, Morano HJr. Endothelial vascular function in hypertensive patients after renin-angiotensin system blockade. J Clin Hypertens 2006;8:803-9.

  36. Caldwell PR, Segal BC. Angiotensin-converting enzyme: vascular endotelial localization. Science 1976;191:1050-1.

  37. Bradley HA, Wysonge CS. How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systematic review and meta-analysis. J Clin Hpertens 2006;11:2131-41.

  38. Michelakis AM, McAllister RG. The effect of chronic adrenergic receptor blockade on plasma rennin activity in man. J Clin Endocrinol Metab 1972;34:386-94.

  39. Ayers CR, Harris RH. Control of rennin release in experimental hypertension. Cir Res 1969;5:103-12.

  40. Kruger C, Rauh M. Immunoreactive rennin concentrations in healthy children from birth to adolescence. Clin Chim Acta 1998;27:15-27.

  41. Brons M, Thayssen P. Plasma rennin concentration, activity and substrate in normal children. Acta Med Scand 1983;677:89-92.

  42. Rodríguez-Iturbe B, Baggio B, Colina-Chourro J, Favero S, García R, Sussane F, Castillo L, Borsatti A. Studies on the rennin-aldosterone system in the acute nephritic syndrome. Kidney Int 1981;19:45-53.

  43. Stalker HP, Holland NH, Kotchen JM, Kotchen TA. Plasma rennin activity in healthy children. J Pediatr 1976;89:256-8.

  44. Simoes e Silva AC, Diniz JS. Circulating renin angiotensin system in childhood chronic renal failure: marked increase of angiotensin-( 1-7) in end-stage renal disease. Pediatr Res 2006;60:734-9.

  45. Hayduk K, Krause D. Age-dependent changes of plasma rennin concentration in humans. Clin Sci Mol Med 1973;45:273-8.

  46. Mtinlauri I, Slola JU, Aalto IA, Koskinen P, Irjala K. Timeresolved immunofluorometric assay of total renin in plasma and follicular fluid. Clin Chem 1994;40:74-9.

  47. Coates JE, Chapelsy LJ. Pediatric reference intervals for plasma renin. Clin Biochem 1994;74:316-8.




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