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Órgano Oficial del Instituto Nacional de Pediatría

2014, Number 3

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Acta Pediatr Mex 2014; 35 (3)

Treatment of arterial hypertension in children, based on its pathophysiology and on the determination of direct renin in plasma

Castañeda-Aguilar JA, Zaltzman-Girshevich S, Murata C, Espino-Vela J

Language: Spanish
References: 40
Page: 190-201
PDF size: 671.89 Kb.


ABSTRACT

Background: The effectiveness of the treatment of arterial hypertension based on the level of renin (Renin-Guided Treatment of Hypertension, RGTH), has been demonstrated in adults. In the pediatric population there is only one retrospective study that suggests the benefit of using this algorithm in children with hypertension.
Objectives: To compare the time needed to control arterial hypertension in two groups of children. One group consisting of patients in which there is a relationship between the clinical diagnosis and plasma renin levels, and the other group without this condition. Also to identify the combination of clinical variables that optimize differential diagnosis of arterial hypertension through a differential model.
Material and methods: A comparative cohort study (observational, prospective and longitudinal) of hypertensive children studied at Instituto Nacional de Pediatría was done. We evaluated the concordance between the clinical diagnosis of the type of hypertension and the results of plasma renin levels. We recorded and compared the time required to normalize blood pressure in two groups of patients: the group of patients with a relationship between the clinical diagnosis and direct renin levels, and another group of patients without this relationship. A selective model was constructed to identify the combination of clinical variables that optimize differential diagnoses for diverse types of hypertension.
Results: There were 34 patients in the group with a relationship between the clinical diagnosis and the renin levels, and 4 in the group without this relation. The median time median to normalize arterial blood pressure in the first group was 3 days (95% CI 2-7) and for the other group was 12.5 days (95% CI 4.5-28). This difference was marginally significant (Log-rank: p=0.064). We obtained a model that discriminates 100% of the time between the 2 types of hypertension through clinical diagnostic variables (medical history and physical examination).
Conclusions: This study suggests the benefit and safety of treatment for hypertensive children using the RGTH algorithm, resulting in a control of hypertension in a shorter period of time.


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