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May 10, 2021
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May 10, 2021
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Abstract

Background


An increasing number of healthy children and  adolescents  across  the  world  are being   diagnosed   with   hypertension, which  is  an  emerging  problem  that  no pediatrician can afford to ignore. Hypertension in children is defined as systolic BP (SBP) and/or diastolic BP (DBP) ≥95th percentile for sex, age, and height on ≥3 occasions. It occurs in 1%–10% of children and adolescents and, at younger ages, frequently has a cardiac or renal cause. Losartan, an Angiotensin II Receptor Blocker (ARB), is an antihypertensive therapy with demonstrated benefit in children.


Objectives


Once-daily Losartan reduces Blood Pressure in a dose-dependent manner and is well tolerated in hypertensive children aged 6–16 years. This study assessed the dose-response relationship, safety, and tolerability of Losartan in hypertensive children aged 61 year to 5 years.


Design


This was a 10-week, randomized, open-label, dose-ranging study.


Duration


One year (November 2016 - December 2017)


Setting


Gandhi Medical College, Hyderabad.


Participants


Sixty patients diagnosed at Gandhi Medical College, Hyderabad.


Methods


Patients were randomized to Losartan at the following dosages: 0.1 mg/kg per day (low), 0.3 mg/kg per day (medium), or 0.7 mg/kg per day (high). Losartan was titrated to the next dose level (to a 1.4 mg/kg per day maximum dosage, not exceeding 100 mg/d, which was not one of the three original doses offered at randomization) at weeks 3, 6, and 9 for patients who did not attain their goal BP and were not taking the highest dose. Dose response was evaluated by analyzing the slope of change in sitting systolic BP (SBP; primary end point) and diastolic BP (DBP; secondary end point) after 3 weeks compared with baseline. Adverse events (AEs) were recorded throughout.


Results


Mean sitting BP decreased from baseline in the low, medium, and high-dose groups by 7.2, 7.4, and 6.8 mmHg, respectively, for SBP and 8.0, 5.2, and 6.7 mmHg, respectively, for DBP after 3 weeks. No dose-response relationship was established by the slope analysis on SBP (P=0.74) or DBP (P=0.63). The BP-lowering effect was observed throughout the one year extension.


Conclusions


Hypertensive children aged 1 year to 6 years treated with Losartan 0.1–0.7 mg/kg per day had clinically significant decreases from baseline in SBP and DBP, yet no dose-response relationship was evident. Losartan, at a dosage up to 1.5 mg/kg per day, was well tolerated.

Keywords

Hypertension Children Management ARB Losartan

Article Details

How to Cite
Dr. S. Umamaheswara Raju, Dr. J. Margaret Viola, & Dr P. Raghunadha Rao. (2021). Losartan in management of hypertension in children. International Journal of Research in Pharmacology & Pharmacotherapeutics, 7(4), 313-319. https://doi.org/10.61096/ijrpp.v7.iss4.2018.313-319
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References

  1. [1]. Sinaiko AR: Hypertension in children. N Engl J Med 335, 1968, 1973, 1996
  2. [2]. Flynn JT, Meyers KE, Neto JP, de Paula Meneses R, Zurowska A, Bagga A, Mattheyse L, Shi V, Gupte J, Solar-Yohay S, Han G; Pediatric Valsartan Study Group: Efficacy and safety of the an-giotensin receptor blocker valsartan in children with hyperten-sion aged 1 to 5 years. Hypertension 52, 2008, 222–228.
  3. [3]. Mitsnefes M, Ho PL, McEnery PT: Hypertension and progres-sion of chronic renal insufficiency in children: A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). J Am SocNephrol 14, 2003, 2618–2622.
  4. [4]. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114[2], 2004, 555–576.
  5. [5]. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A: A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58, 1976, 259–263.
  6. [6]. Broughton Pipkin F, Smales OR, O’Callaghan M: Renin and an-giotensin levels in children. Arch Dis Child 56, 1981, 298–302.
  7. [7]. Hahn L. The relation of blood pressure to weight, height and body surface area in school boys. Arch Dis Child. 27, 1952, 43–53
  8. [8]. Orchard TP, Hedley AJ, Mitchell JR. The distribution and associations of blood pressure in an adolescent population. J Epidemiol Community Health. 36, 1982, 35–42
  9. [9]. Gupta AK, Ahmed AJ. Normal blood pressure and evaluation of sustained blood pressure and evaluation of sustained blood pressure elevation in childhood. Indian Pediatr. 27, 1990, 33–42
  10. [10]. Verma M, Chhatwal J, George SM. obesity and hypertension in children. Indian Pediatr. 1, 1994, 1065–9
  11. [11]. Loria D, Sharma M, Diwedi V, Belapurkar KM, Mathur PS. Profile of blood Pressure in normal school children. Indian Pediatr. 26, 1989, 531–6
  12. [12]. Aggarwal VK, Sharon R, Srivastava AK, Kumar P, Pandey CM. Blood Pressure profile in children of age 3-15 years. Indian Pediatr. 20, 1983, 921–5
  13. [13]. Burke GL, Cresanta JL, Shear CL, Miner MH, Berenson GS. Cardiovascular risk factors and their modification in children. CardiolClin. 4, 1986, 33–6
  14. [14]. Jackson LV, Thalange NK, Cole TJ. Blood pressure centiles for Great Britain. Arch Dis Child. 92, 2007, 298–303
  15. [15]. Irgil E, Erkenci Y, Ayetekin N, Ayetekin H. prevalence of hypertension in School children aged 13-18 yrs in Gemlike, Turkey. Euro J Public Health. 40, 1998, 176–8.
  16. [16]. Ng’andu NH. Blood pressure levels of Zambian rural adolescents and their.Relationship to age, sex, weight, height and three weights for height indices. Int J Epidemiol. 21, 1992, 246–52
  17. [17]. Dannenberg AL, Garrison RJ, Kennel WB. Incidence of hypertension in the Framingham study. Am J Public Health. 78, 1998, 676–9
  18. [18]. Thakor HG, Kumar P, Desai VK. An epidemiological study of hypertension amongst children from various primary schools of Surat city. Indian J Community Med. 23, 1998, 110–5
  19. [19]. Torok E, Gyrafas I, Csukas M. Factors associated with stable high blood Pressure in adolescents. J Hypertens. 3(3), 1985, 389–90
  20. [20]. Aullen JP. Obesity, hypertension and their relationship in children and adolescents.An epidemiological study in schools (Authors transl) Sem Hop. 54, 1978, 637–43
  21. [21]. Hardy R, Wadsworth ME, Langenberg C, Kuh D. Birth weight, childhood growth and blood pressure at 43 yrs in a British birth cohort. Int J Epidemiol. 33, 2004, 121–9
  22. [22]. Andriska J, Gombik M, Breyer H, Tarr A. Hypertension in children and adolescents.Results of a long term follow up study 1975-1985. ClinExpHypertens A. 8, 1986, 567–9
  23. [23]. Lascaux-Lefebvre V, Ruidavets J, Arveiler D, Amouyel P, Haas B, Cottel D, et al. Influence of parental history of hypertension on blood pressure. J Hum Hypertens. 3, 1999, 631–6.