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The cardiovascular phenotype of childhood hypertension: a cardiac magnetic resonance study. Pediatr Radiol 2019; 49:727-736. [PMID: 31053874 PMCID: PMC6614159 DOI: 10.1007/s00247-019-04393-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/07/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cardiovascular phenotype is poorly characterized in treated pediatric hypertension. Cardiovascular magnetic resonance imaging (MRI) can be used to better characterize both cardiac and vascular phenotype in children with hypertension. OBJECTIVE To use MRI to determine the cardiac and vascular phenotypes of different forms of treated hypertension and compare the results with those of healthy children. MATERIALS AND METHODS Sixty children (15 with chronic renal disease with hypertension, 15 with renovascular hypertension, 15 with essential hypertension and 15 healthy subjects) underwent MRI with noninvasive blood pressure measurements. Cardiovascular parameters measured include systemic vascular resistance, total arterial compliance, left ventricular mass and volumetric data, ejection fraction and myocardial velocity. Between-group comparisons were used to investigate differences in the hypertension types. RESULTS Renal hypertension was associated with elevated vascular resistance (P≤0.007) and normal arterial compliance. Conversely, children with essential hypertension had normal resistance but increased compliance (P=0.001). Renovascular hypertension was associated with both increased resistance and compliance (P≤0.03). There was no difference in ventricular volumes, mass or cardiac output between groups. Children with renal hypertension also had lower systolic and diastolic myocardial velocities. CONCLUSION Cardiovascular MRI may identify distinct vascular and cardiac phenotypes in different forms of treated childhood hypertension. Future studies are needed to investigate how this may inform further optimisation of blood pressure treatment in different types of hypertension.
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Thorsteinsdottir H, Dorenberg E, Line PD, Bjerre A. [Renovascular disease in children - a rare diagnosis with few symptoms]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:279-282. [PMID: 28225234 DOI: 10.4045/tidsskr.16.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND To estimate the prevalence, symptoms, causes and treatment of renovascular disease in children, and also to assess the degree of secondary organ damage to the heart, kidneys and eyes (end organ damage).MATERIAL AND METHOD Retrospective review of data for all children (0 - 16 years) who were examined for resistant hypertension in the period 1998 - 2013 at Oslo University Hospital Rikshospitalet.RESULTS A total of 21 children/adolescents (median age 8.5 years, 11 girls) were assessed and treated for resistant hypertension in the study period. Altogether had 38 % no symptoms at the time of diagnosis and 19 % had classical symptoms of hypertension. Fifteen patients received invasive treatment in the form of percutaneous transluminal renal angioplasty (PTRA) (n = 5), nephrectomy (n = 6), coiling (n = 1), autotransplantation (n = 1) or a combination of these (n = 2). Blood pressure improved following treatment in 10 of 14 patients for whom outcomes were recorded in the medical records. End organ damage to the heart and retina was observed in 60 % and 50 % of patients, respectively.INTERPRETATION Children with severely elevated blood pressure as a result of renovascular disease often have unspecific or no symptoms. Blood pressure improved following invasive treatment in 10 of 14 children and few complications were recorded. Invasive treatment may be considered in children and adolescents when standard treatment for hypertension is insufficient.
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Affiliation(s)
| | | | - Pål-Dag Line
- Avdeling for transplantasjonsmedisin og Institutt for klinisk medisin Universitetet i Oslo
| | - Anna Bjerre
- Barne- og ungdomsklinikken Oslo universitetssykehus
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Horn DG, Trame MN, Hempel G. The management of hypertensive emergencies in children after stem cell transplantation. Int J Clin Pharm 2011; 33:165-76. [PMID: 21394568 DOI: 10.1007/s11096-011-9495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
Abstract
AIM OF THE REVIEW This work presents a short overview on the available data about drugs that are currently used to treat hypertensive emergencies in children with a focus on incidents after stem cell transplantation. It shows that the pediatric use of all hypotensive agents appears to be mainly based on personal experience of the attending physicians rather than on convincing clinical trials. METHOD A literature search was performed in MEDLINE, through PubMed, using the medical subject headings (MeSH) hypertensive emergencies, nifedipine, nicardipine, and children. Further articles were identified by checking cross-references of articles and books. RESULTS Hypertensive emergencies in children after stem cell transplantation usually have a renal etiology, because of the treatment with the calcineurin inhibitors cyclosporine and tacrolimus. In these severe cases an immediate action is necessary to avoid possible appearance or exacerbation of endorgan damage. Because of their mechanism of action and a potential nephroprotective effect calcium channel blockers may be particularly suitable in cases of hypertensive emergencies. An intravenous application of nifedipine may compensate the difficulties of accurate dosing, but keeping in mind possible severe side effects and the lack of published experience its use in children is at least questionable. Nicardipine appears to be the hypotensive agent of first choice. In adults, the treatment of hypertensive emergencies with intravenous nicardipine is well-documented, but for an evaluation of safety in pediatric use, the published studies and case reports appear to be barely adequate. CONCLUSION The actual treatment approaches vary widely, demonstrating the lack of hard science on which current treatment of hypertensive emergencies in children is based. The hypotensive agent for the individual situation should be chosen considering the properties, side effects, the limited experiences with its use and the patient's anamnesis.
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Affiliation(s)
- D G Horn
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Münster, Germany
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Tullus K, Roebuck DJ, McLaren CA, Marks SD. Imaging in the evaluation of renovascular disease. Pediatr Nephrol 2010; 25:1049-56. [PMID: 19856000 PMCID: PMC2855432 DOI: 10.1007/s00467-009-1320-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 08/23/2009] [Accepted: 08/24/2009] [Indexed: 10/26/2022]
Abstract
Renovascular disease (RVD) is an important cause of hypertension in children, as it often is amenable to potentially curative treatment. Imaging aimed at finding RVD therefore needs to have high sensitivity so as not to miss important findings. Digital subtraction angiography is the gold standard investigation. Doppler ultrasonography, computed tomography (CT) angiography and magnetic resonance (MR) angiography can all be helpful, but none has, at present, high enough sensitivity to rule out RVD in a child with a suggestion of that diagnosis.
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Affiliation(s)
- Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Derek J. Roebuck
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Clare A. McLaren
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Stephen D. Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH UK
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Lee JH. Treatment of chronic kidney disease in children. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.10.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Joo Hoon Lee
- Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Assessment of the use of angiotensin receptor blockers in major European markets among paediatric population for treating essential hypertension. J Hum Hypertens 2008; 23:420-5. [PMID: 19052566 DOI: 10.1038/jhh.2008.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Renovascular disease is an uncommon but important cause of hypertension in children. It is usually diagnosed after a long delay because blood pressure is infrequently measured in children and high values are generally dismissed as inaccurate. Many children with renovascular disease have abnormalities of other blood vessels (aorta, cerebral, intestinal, or iliac). Individuals suspected of having the disorder can be investigated further with CT, MRI, or renal scintigraphy done before and after administration of an angiotensin-converting-enzyme inhibitor, but angiography is still the gold standard. Most children with renovascular disease will need interventional or surgical treatment. Endovascular treatment with or without stenting will cure or reduce high blood pressure in more than half of all affected children. Surgical intervention, if needed, should be delayed preferably until an age when the child is fully grown. Modern treatment provided by a multidisciplinary team of paediatric nephrologists, interventional radiologists, and vascular surgeons offers good long-term treatment results.
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Affiliation(s)
- Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Abstract
PURPOSE OF REVIEW Mendelian forms of hypertension are rare genetic disorders that cause severe hypertension. This review will explore the recently identified molecular mechanisms and pathogenesis of genetic disorders that cause hypertension in children. RECENT FINDINGS Hypertension is now believed to be a polygenic disorder resulting from the interaction of multiple genes and the environment. A few forms of severe hypertension have been linked to single genes. The genes responsible for these disorders have all been cloned and all participate in pathways involved in heightened renal sodium reabsorption. The increased sodium reabsorption arises in the distal nephron and leads to volume expansion and hypertension. SUMMARY Investigating forms of monogenic hypertension has advanced the understanding of sodium transport and volume control by the kidney. Future studies will identify novel genes, pathways and treatment targets important in the fight against primary hypertension.
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Affiliation(s)
- Scott S Williams
- UT Southwestern Medical Center at Dallas, Texas 75390-9063, USA.
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Harrabi I, Belarbia A, Gaha R, Essoussi AS, Ghannem H. Epidemiology of hypertension among a population of school children in Sousse, Tunisia. Can J Cardiol 2006; 22:212-6. [PMID: 16520851 PMCID: PMC2528915 DOI: 10.1016/s0828-282x(06)70898-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pediatric hypertension is a field of increasing interest and importance. Early identification of children at risk for hypertension is important to prevent the serious, long-term complications associated with the condition. In Tunisia, there are no data available on the cardiovascular disease risk profile, such as hypertension, in the population of children. OBJECTIVE To establish the prevalence of hypertension, the percentile distribution of blood pressure and the inter-relationships between hypertension and other cardiovascular disease risk factors among school children. METHODS An epidemiological survey was conducted based on a representative sample of 1569 urban school children in Sousse, Tunisia. RESULTS The prevalence of arterial hypertension was 9.6%, with no significant difference between boys (9.2%) and girls (9.9%). The prevalence of systolic and diastolic hypertension was 6.4% and 4.5%, respectively. In both boys and girls, systolic pressure had a highly significant positive correlation with height (boys: r=0.33, P<0.001; girls: r=0.08, P=0.02), weight (boys: r=0.47, P < or = 0.001; girls: r=0.35, P<0.001) and triglyceride concentrations (boys: r=0.13, P<0.001; girls: r=0.10, P=0.006). Among boys, a positive correlation was found between systolic blood pressure and age (r=0.12, P=0.001) and, among girls, a negative correlation was found (r=-0.12, P=0.001). CONCLUSION This information will be used to help launch a regional program of heart health promotion in schools.
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Affiliation(s)
- Imed Harrabi
- Service of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia.
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Valentini RP, Langenburg S, Imam A, Mattoo TK, Zerin JM. MRI detection of atrophic kidney in a hypertensive child with a single kidney. Pediatr Nephrol 2005; 20:1192-4. [PMID: 15940544 DOI: 10.1007/s00467-005-1914-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Revised: 02/08/2005] [Accepted: 02/09/2005] [Indexed: 11/26/2022]
Abstract
The role of magnetic resonance imaging (MRI) in the work-up of secondary causes of pediatric hypertension is typically restricted to that of renovascular causes where main renal artery stenosis is suspected. We report a case of a 10-year-old female child with hypertension, who was thought to have unilateral renal agenesis, because only a solitary left kidney could be visualized on both ultrasound and renal scintigraphy. Our patient underwent magnetic resonance imaging because of suspected renal artery stenosis in her solitary left kidney. At MRI she was found to have a normal left kidney. However, a very tiny, atrophic right kidney was also visualized. A laparoscopic right nephrectomy was performed, which resulted in complete resolution of her hypertension. This case illustrates a possible additional role for MRI in a very small subset of pediatric hypertensive patients: those with a single kidney on ultrasound.
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Affiliation(s)
- Rudolph P Valentini
- The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201-2196, USA.
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Abstract
Improved recognition of the relationship between childhood and adult blood pressures and identification of end-organ damage in children, adolescents, and young adults with hypertension has led to increased focus by pediatricians and general practitioners on the detection, evaluation, and treatment of hypertension. Notably, detection, evaluation, and treatment of pediatric hypertension has increased significantly since the first Task Force Report on High Blood Pressure in Children and Adolescents in 1977 with advances in both nonpharmacologic and pharmacologic treatments.Angiotensin-converting enzyme inhibitors (e.g. captopril, enalapril, lisinopril, ramipril) and calcium channel antagonists (e.g. nifedipine, amlodipine, felodipine, isradipine) are the most commonly prescribed antihypertensive medications in children due to their low adverse-effect profiles. Diuretics (e.g. thiazide diuretics, loop diuretics, and potassium-sparing diuretics) are usually reserved as adjunct therapy. Newer agents, such as angiotensin receptor antagonists (e.g. irbesartan), are currently being studied in children and adolescents. These agents may be an option in children with chronic cough secondary to angiotensin-converting enzyme inhibitors. beta-Adrenoreceptor antagonists (e.g. propranolol, atenolol, metoprolol, and labetalol), alpha-adrenoreceptor antagonists, alpha-adrenoreceptor agonists, direct vasodilators, peripheral adrenoreceptor neuron agonists, and combination products are less commonly used in pediatric patients because of adverse events but may be an option in children unresponsive to calcium channel blockers, angiotensin converting-enzyme inhibitors, or angiotensin receptor blockers.
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Affiliation(s)
- Renee F Robinson
- Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Columbus, OH 43205, USA.
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Abstract
Despite the existence of a variety of consistent hypertension guidelines,the issue of inadequate management of the condition persists. The challenge for health care professionals is not only to understand and adopt the guidelines but also to take a holistic approach to patient care. In addition, clinicians need to encourage adherence to medication protocols, which will hopefully lead to an overall reduction in morbidity and mortality associated with hypertension. It is the clinician's professional responsibility to be cognizant of the emerging research on vasoactive substances as new drugs are being developed that will effect endothelial receptors. It is important that clinicians are trained appropriately in blood pressure measurement and risk factor identification and intervention.
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Affiliation(s)
- Karen L Then
- University of Calgary Faculty of Nursing, 2500 University Drive, Calgary, Alberta T2N 1N4, Canada.
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References. Am J Kidney Dis 2004. [DOI: 10.1053/j.ajkd.2004.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tanaka H, Tateyama T, Suzuki K, Nakahata T, Kudo M, Takahashi Y, Ito E, Waga S. Acute renal failure due to hypertension: malignant hypertension in an adolescent. Pediatr Int 2003; 45:342-4. [PMID: 12828593 DOI: 10.1046/j.1442-200x.2003.01730.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hiroshi Tanaka
- Departments of Pediatrics, Hirosaki University School of Medicine, Odate Municipal General Hospital and National Aomori Hospital, Hirosaki, Japan.
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PEREZ-BRAYFIELD MARCOSR, GATTI JOHNM, SMITH EDWINA, BROECKER BRUCE, MASSAD CHARLOTTE, SCHERZ HAL, KIRSCH ANDREWJ. Blunt Traumatic Hematuria in Children. Is a Simplified Algorithm Justified? J Urol 2002. [DOI: 10.1016/s0022-5347(05)65033-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- MARCOS R. PEREZ-BRAYFIELD
- From the Division of Pediatric Urology, Department of Urology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - JOHN M. GATTI
- From the Division of Pediatric Urology, Department of Urology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - EDWIN A. SMITH
- From the Division of Pediatric Urology, Department of Urology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - BRUCE BROECKER
- From the Division of Pediatric Urology, Department of Urology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - CHARLOTTE MASSAD
- From the Division of Pediatric Urology, Department of Urology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - HAL SCHERZ
- From the Division of Pediatric Urology, Department of Urology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - ANDREW J. KIRSCH
- From the Division of Pediatric Urology, Department of Urology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
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Blunt Traumatic Hematuria in Children. Is a Simplified Algorithm Justified? J Urol 2002. [DOI: 10.1097/00005392-200206000-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Hypertension is relatively uncommon in children and few children receive antihypertensive medications. This article reviews the safety of calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in children with hypertension. While the newer antihypertensive agents appear to be well-tolerated by children, further studies are needed to determine the safety profile across the developmental continuum, with chronic dosing and in children with complex hypertension.
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Affiliation(s)
- Douglas L Blowey
- Pediatric Nephrology, School of Medicine, University of Missouri-Kansas City, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Leonard MB, Kasner SE, Feldman HI, Schulman SL. Adverse neurologic events associated with rebound hypertension after using short-acting nifedipine in childhood hypertension. Pediatr Emerg Care 2001; 17:435-7. [PMID: 11753188 DOI: 10.1097/00006565-200112000-00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Short-acting nifedipine (SA-NIF) is widely prescribed for acute hypertension (HTN) in children despite reports of ischemic complications in adults. We describe two children with neurologic events caused by rebound hypertension following SA-NIF use. CASES Patient 1 is a 7-year-old with acute nephritis and blood pressure (BP) of 185/130. She received SA-NIF which decreased BP to 114/79. When BP rebounded to 160/103, she developed severe cortical visual impairment. Head CT demonstrated edema and petechial hemorrhages in the watershed region. Patient 2 is a 10-year-old renal transplant recipient who received SA-NIF for a BP of 155/98, which resulted in a prompt decrease to 114/74. Two hours later he developed aphasia and right-sided neglect. His BP increased to 168/88 and he developed partial complex seizures. Brain MRI showed high signal intensity in the watershed areas with early gadolinium enhancement. DISCUSSION The temporal association of the neurologic events with the rebound increase in BP suggests a possible role for the SA-NIF, consistent with its pharmacokinetic profile. Although the adult literature has focused on the unpredictable decline in BP after SA-NIF treatment, these cases suggest that rapid increases in BP following the maximal SA-NIF effect may be associated with impaired cerebral autoregulation and encephalopathy in children. These cases underscore the need for frequent blood pressure determinations and therapy to prevent rebound hypertension.
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Affiliation(s)
- M B Leonard
- Department of Pediatrics, The Children's Hospital of Philadelphia, PA 19104, USA.
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Sakarcan A, Tenney F, Wilson JT, Stewart JJ, Adcock KG, Wells TG, Vachharajani NN, Hadjilambris OW, Slugg P, Ford NF, Marino MR. The pharmacokinetics of irbesartan in hypertensive children and adolescents. J Clin Pharmacol 2001; 41:742-9. [PMID: 11452706 DOI: 10.1177/00912700122010645] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An open-label study was conducted to characterize the pharmacokinetics and antihypertensive response to irbesartan in children (1-12 years) and adolescents (13-16 years) with hypertension. Patients received single once-daily oral doses of irbesartan 2 mg/kg (maximum of 150 mg once daily) for 2 to 4 weeks (+/- nifedipine or hydrochlorothiazide). Plasma irbesartan concentrations were determined by a validated high-performance liquid chromatography/fluorescence method from blood samples taken predose, up to 24 hours after dosing on Day 1, and up to 48 hours after the final dose. The plasma concentration-time profiles were similar between the 6- to 12-year and the 13- to 16-year age groups and to that previously determined from a study of adult subjects receiving approximately 2 mg/kg (i.e., 150 mg) oral irbesartan once daily. Mean reductions in systolic/diastolic blood pressure were 16/10 mmHg at Day 28 with irbesartan monotherapy (n = 8). Irbesartan was well tolerated and may be a treatment option for pediatric hypertensive patients.
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Affiliation(s)
- A Sakarcan
- Louisiana State University Health Sciences Center, Shreveport, USA
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Kater CE, Costa-Santos M. O espectro das síndromes de hipertensão esteróide na infância e adolescência. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0004-27302001000100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hipertensão arterial não é privilégio de adultos. Além de causas renais e vasculares, doenças adrenocorticais ou correlatas devem ser consideradas na investigação da criança e adolescente hipertensos. O receptor mineralocortidóide (MC) pode ser ativado tanto por MC típicos como pelo cortisol, e mesmo funcionar de maneira autônoma, decorrente de distúrbio nos canais de sódio. Assim, hiperatividade MC (hipertensão, hipocalemia e supressão de renina) pode resultar do excesso de: (1) aldosterona, (2) deoxicorticosterona (DOC) e (3) cortisol. O primeiro grupo, denominado hiperaldosteronismo primário (HAP), inclui o adenoma, o carcinoma e a hiperplasia produtora de aldosterona, além de causa familiares: HA supressível por dexametasona (ou tipo I) e o tipo II. O segundo grupo engloba os tumores produtores tanto de DOC, como de andrógenos ou estrógenos, e a produção de DOC secundária ao excesso de ACTH (síndrome de Cushing, hiperplasia adrenal congênita por deficiência de 11beta- e 17alfa-hidroxilases e síndrome de resistência periférica ao cortisol). Na síndrome do excesso aparente de MC, cortisol age como um MC graças à deficiência congênita ou à inibição (pelo alcaçuz) da enzima 11beta-hidroxisteróide desidrogenase, responsável pela oxidação do cortisol em cortisona. Sódio e fluidos podem ser absorvidos nos túbulos renais de forma inapropriada, tanto na síndrome de Liddle (mutações ativadoras do gene do canal epitelial de sódio) como na de Arnold-Healy-Gordon (onde a hiperreabsorção de cloretos e sódio no túbulo renal impede a excreção de H+ e K+, produzindo hipertensão com acidose e hipercalemia). Todo este espectro de doenças adrenais hipertensivas, apesar de pouco prevalentes, deve ser lembrado com possível causa da hipertensão que pode ocorrer na infância e adolescência.
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Abstract
Amlodipine, a long-acting dihydropyridine calcium channel blocking agent, was administered to 55 children (age: 11.5 +/- 5.4 years) with hypertension, 49 of whom (89%) had secondary hypertension. Efficacy was assessed by comparing pretreatment blood pressure (BP) to follow-up BP obtained in our outpatient Pediatric Nephrology clinic. Thirty-two (58%) patients achieved BP control with amlodipine alone, and 31 (55%) patients received amlodipine twice daily. Eleven patients received amlodipine as a suspension. Mean amlodipine dose was 0.16 +/- 0.12 mg/kg/day; there was an inverse relationship between patient age and amlodipine dose. Follow-up BP were significantly lower than pretreatment BP: systolic BP fell from 129 +/- 12 to 122 +/- 12 mm Hg (P = .004), and diastolic BP fell from 78 +/- 13 to 70 +/- 19 mm Hg (P = .003). A small, clinically insignificant increase in heart rate (from 91 +/- 19 beats/min to 99 +/- 26 beats/min; P = .02) occurred during amlodipine treatment. Adverse effects reported included dizziness (three patients), fatigue (two patients), flushing (two patients), and leg edema (one patient). All improved with dose reduction. We conclude that amlodipine provides effective BP control without significant adverse effects in children with hypertension, and can be used as monotherapy in most children. Young children appear to require significantly higher doses per kilogram of body weight than older children. Twice-daily dosing may be required in many children to achieve BP control. Detailed pharmacokinetic studies are needed to confirm these observations.
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Affiliation(s)
- J T Flynn
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, USA.
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Abstract
Ambulatory blood pressure monitoring (ABPM) has become more widely used in the assessment of elevated blood pressure in children. The accurate diagnosis of white coat hypertension (WCH) is particularly important in children because detection of elevated blood pressure often results in expensive and invasive diagnostic procedures to detect underlying disease. Recent normative pediatric data have both enhanced our ability to interpret ABPM results in pediatric patients and increased awareness that children suffer from WCH as has already been reported in adults. The few studies of WCH in children report a prevalence ranging from 44-88%, depending on the choice of threshold values for normalcy. When persistent hypertension is confirmed by three blood pressure measurements on three different occasions, ABPM should be performed as part of the initial evaluation. If hypertension is confirmed by ABPM, further evaluation should be tailored to the individual patient depending on the age, severity of hypertension, associated risk factors, and presence of end-organ injury.
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Affiliation(s)
- J M Sorof
- Section of Nephrology and Hypertension, Department of Pediatrics, University of Texas - Houston School of Medicine, Houston 77030, USA.
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Affiliation(s)
- J M Sorof
- Division of Nephrology and Hypertension, Department of Pediatrics, University of Texas-Houston School of Medicine, Houston, TX 77030, USA
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ADVANCED PRACTICE NURSING IN PEDIATRIC NEPHROLOGY. Nurs Clin North Am 2000. [DOI: 10.1016/s0029-6465(22)02447-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
We conducted a MEDLINE search from January 1966-March 1999 to obtain information on clinical trials of treatment of pediatric hypertension. An article was selected for review if it described a randomized or nonrandomized study; randomized studies were given priority. Case reports were considered when studies were unavailable. Review articles were useful in identifying references. According to data we collected, hypertension is present in 1-3% of the pediatric population. Nonpharmacologic treatment may be effective initially in those with mild to moderate disease or as an adjunct to drug therapy. Drugs for treatment of chronic hypertension include calcium channel blockers, angiotensin-converting enzyme inhibitors, diuretics, and beta-blockers. Patient and drug characteristics determine therapy. Intravenous labetalol, nicardipine, and nitroprusside are effective for treating hypertensive emergencies.
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Affiliation(s)
- M E Temple
- Colleges of Pharmacy, The Ohio State University, Columbus 43210, USA
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