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Pediatric Nephrology
Published in: Pediatric Nephrology 9/2017

01-09-2017 | Original Article

Race, obesity, and the renin-angiotensin-aldosterone system: treatment response in children with primary hypertension

Authors: Andrew M. South, Lester Arguelles, Gal Finer, Craig B. Langman

Published in: Pediatric Nephrology | Issue 9/2017

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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.
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Metadata
Title
Race, obesity, and the renin-angiotensin-aldosterone system: treatment response in children with primary hypertension
Authors
Andrew M. South
Lester Arguelles
Gal Finer
Craig B. Langman
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 9/2017
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-017-3665-9

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