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Ambulatory blood pressure monitoring for the assessment of cardiovascular risk in hypertensive children
204A
POSTERS: Pediatric Hypertension
reduction (7.9 vs. 1.4, p⫽0.012). In contrast, in subjects with baseline SBP and DBP ⬍5 mmHg above the 95th %tile (n⫽37), no significant differences between B/HT and placebo were found for SBP reduction (7.5 vs. 8.4, p⫽0.78) or DBP reduction (5.7 vs. 3.6, p⫽0.67). Differences between B/HT and placebo were independent of gender, Tanner stage, race, and randomization criteria. Conclusion: Overall, B/HT reduced BP compared to placebo. However, the lack of difference between B/HT and placebo in adolescents with mild to moderate BP elevation raises questions over whether antihypertensive therapy should be used in these patients prior to several months of observation. Key Words: Child, Antihypertensive Therapy, Clinical Trials
P-474 EFFECTS OF THE ANGIOTENSIN II RECEPTOR ANTAGONIST, LOSARTAN, IN CHILDREN AGE 6-16 YEARS WITH HYPERTENSION Beth Soffer, Emanuela Santoro, Pamela Herrera, Zhongxin Zhang, Kenneth Miller, Francisco Cano, Jeffrey Blumer, Igor Briazgounov, Shahnaz Shahinfar. Merck & Co., Inc., West Point, PA, United States; Nephrology & Hypertension, Park Ridge, IL, United States; Hosp. Luis Calvo Mackenna, Santiago, Chile; Univ. Hospitals of Cleveland, Cleveland, OH; Ped. Research Center, Moscow, Russian Federation. This is the first and largest multicenter study in the use of an angiotensin II receptor antagonist in children with hypertension. This study was designed to assess the antihypertensive safety and efficacy of losartan (COZAAR威) in children with hypertension age 6 to 16 years. The study was comprised of 177 patients. After an up to one week washout from prior antihypertensive therapy, patients with trough sitting diastolic blood pressure ⬎ 95% for gender, age and height were randomized to receive 1 of 3 losartan treatments once daily for 21 days: 2.5/5 mg, 25/50 mg, or 50/100 mg. Patients who weighed ⬍50 kg received the lower dose in the respective treatment groups (2.5, 25, or 50 mg), and patients who weighed ⱖ50 kg received the higher dose (5, 50, or 100 mg). Patients in the 50/100 mg group received a half dose for the first 2 days, then were titrated to the full dose. After 3 weeks of double-blind therapy, patients entered a randomized washout period where they were either continued on their current study regimen or switched to placebo for up to 2 weeks, or when their blood pressure returned to baseline, whichever came first. Safety and efficacy results will be provided.
AJH–April 2002–VOL. 15, NO. 4, PART 2
children, echocardiography and ABPM data from children referred to a pediatric hypertension clinic for evaluation were analyzed. Methods: Thirty-seven patients who had undergone echocardiography and ABPM within a 3 month period as part of the initial diagnostic assessment for hypertension were included for analysis. Patients who were receiving antihypertensive medications at the time of ABPM were excluded. A control group of 33 patients who had undergone echocardiography during the same time period for indications other than hypertension was selected for comparison. Inclusion criteria for the control group were: technically adequate study with m-mode measurements to allow calculation of LVMI, no history or documentation of elevated blood pressure, no documented structural abnormalities by previous echocardiography, and no abnormal findings from the current echocardiography study. LVM was calculated using the Devereux equation, LVMI was calculated as LVM/height2.7, and LVH was defined as LVMI ⬎ 51 gm/m2.7. Mean blood pressure (BP), BP load, and BP index (ambulatory BP divided by pediatric ambulatory BP 95th percentile) were calculated. Results: LVMI was greater (41.5 ⫾ 12.0 vs. 32.5 ⫾ 8.1, p⬍0.001), and the prevalence of LVH was higher (27% vs. 0%, p⫽0.001) in hypertensive patients compared to control patients. In the hypertensive patients, LVMI showed the strongest correlation with 24-hour SBP index (r⫽0.46, p⫽0.004) among all demographic and clinical variables analyzed. LVMI also showed significant correlations with 24-hour SBP (r⫽0.34, p⫽0.042), 24-hour SBP load (r⫽0.36, p⫽0.031), sleep SBP (r⫽0.33, p⫽0.048), and sleep SBP load (r⫽0.38, p⫽0.021). LVMI did not correlate significantly with age, weight, clinic BP, or any ambulatory DBP parameters. Hypertensive patients with and without LVH did not differ in age, gender distribution, height, weight, or BMI. Patients with LVH had significantly higher 24-hour SBP (p⫽0.035), sleep SBP (p⫽0.024), and ambulatory SBP index (p⫽0.022) than those without LVH. The prevalence of LVH was 47% (8/17) in patients with both SBP load ⬎ 50% and 24-hour SBP index ⬎ 1.0, compared to 10% (2/20) in patients without these criteria (p⫽0.015). Conclusions: These data demonstrate in hypertensive children that ABPM may be useful for evaluating cardiovascular risk and thereby help determine the need for antihypertensive therapy. Key Words: Child, Ambulatory Blood Pressure, Left Ventricular Hypertrophy
P-476 TREATMENT OF HYPERTENSION WITH RAMIPRIL IN CHILDREN WITH RENAL DISEASES Tomas Seeman, Jiri Dusek, Janusz Feber, Karel Vondrak, Jan Janda. Dept of Pediatrics, University Hospital Motol, Prague, Prague 5, Czech Republic.
Key Words: COZAAR威/losartan, Angiotensin II Receptor Antagonist, Pediatric Hypertension
P-475 AMBULATORY BLOOD PRESSURE MONITORING FOR THE ASSESSMENT OF CARDIOVASCULAR RISK IN HYPERTENSIVE CHILDREN Jonathan Sorof, Gina Cardwell, Tim Poffenbarger, Kathy Franco, Ronald Portman. Pediatrics, University of Texas-Houston Medical School, Houston, TX, United States. Objectives: To determine the ABPM variables most closely associated with LVMI and/or predictive of the presence of LVH in hypertensive
The purpose of the study was to investigate the effect of long-acting ACE-inhibitor ramipril on blood pressure (BP) and proteinuria in children with renal hypertension. We have investigated 15 children and adolescents (mean age 13.7, range 5.0 - 19.8 yrs, 9 girls) with chronic renal diseases (polycystic kidney diseases, glomerulopathies, uropathies) and hypertension. The children have been treated prospectively with ramipril monotherapy for 6 months. BP has been evaluated using ambulatory blood pressure monitoring (ABPM, oscillometric device SpaceLabs 90207). Hypertension was defined as systolic and/or diastolic daytime and/or night-time mean BP ⱖ 95.pc according Soergel et al. (J Pediatr 1997;130:178-184). Proteinuria was measured in 24 hr urine. Glomerular filtration rate (GFR) was assessed using Schwartz formula. Ramipril was given once daily, the starting dose was 1.5 mg/m2/24 hr and this dose was increased after one month if the BP did not dropped below 95.pc. Mean arterial BP decreased in all children after 6 months of ramipril treatment. The mean BP fall was 10.5 and 10.3 mmHg for daytime systolic and daytime diastolic BP resp. and 8.0 and 7.7 mmHg for night-time systolic and night-time diastolic BP resp. In 9 children (60 %) the BP completely normalised (i.e. all BP values ⬍ 95.pc) at the end of
POSTERS: Pediatric Hypertension
reduction (7.9 vs. 1.4, p⫽0.012). In contrast, in subjects with baseline SBP and DBP ⬍5 mmHg above the 95th %tile (n⫽37), no significant differences between B/HT and placebo were found for SBP reduction (7.5 vs. 8.4, p⫽0.78) or DBP reduction (5.7 vs. 3.6, p⫽0.67). Differences between B/HT and placebo were independent of gender, Tanner stage, race, and randomization criteria. Conclusion: Overall, B/HT reduced BP compared to placebo. However, the lack of difference between B/HT and placebo in adolescents with mild to moderate BP elevation raises questions over whether antihypertensive therapy should be used in these patients prior to several months of observation. Key Words: Child, Antihypertensive Therapy, Clinical Trials
P-474 EFFECTS OF THE ANGIOTENSIN II RECEPTOR ANTAGONIST, LOSARTAN, IN CHILDREN AGE 6-16 YEARS WITH HYPERTENSION Beth Soffer, Emanuela Santoro, Pamela Herrera, Zhongxin Zhang, Kenneth Miller, Francisco Cano, Jeffrey Blumer, Igor Briazgounov, Shahnaz Shahinfar. Merck & Co., Inc., West Point, PA, United States; Nephrology & Hypertension, Park Ridge, IL, United States; Hosp. Luis Calvo Mackenna, Santiago, Chile; Univ. Hospitals of Cleveland, Cleveland, OH; Ped. Research Center, Moscow, Russian Federation. This is the first and largest multicenter study in the use of an angiotensin II receptor antagonist in children with hypertension. This study was designed to assess the antihypertensive safety and efficacy of losartan (COZAAR威) in children with hypertension age 6 to 16 years. The study was comprised of 177 patients. After an up to one week washout from prior antihypertensive therapy, patients with trough sitting diastolic blood pressure ⬎ 95% for gender, age and height were randomized to receive 1 of 3 losartan treatments once daily for 21 days: 2.5/5 mg, 25/50 mg, or 50/100 mg. Patients who weighed ⬍50 kg received the lower dose in the respective treatment groups (2.5, 25, or 50 mg), and patients who weighed ⱖ50 kg received the higher dose (5, 50, or 100 mg). Patients in the 50/100 mg group received a half dose for the first 2 days, then were titrated to the full dose. After 3 weeks of double-blind therapy, patients entered a randomized washout period where they were either continued on their current study regimen or switched to placebo for up to 2 weeks, or when their blood pressure returned to baseline, whichever came first. Safety and efficacy results will be provided.
AJH–April 2002–VOL. 15, NO. 4, PART 2
children, echocardiography and ABPM data from children referred to a pediatric hypertension clinic for evaluation were analyzed. Methods: Thirty-seven patients who had undergone echocardiography and ABPM within a 3 month period as part of the initial diagnostic assessment for hypertension were included for analysis. Patients who were receiving antihypertensive medications at the time of ABPM were excluded. A control group of 33 patients who had undergone echocardiography during the same time period for indications other than hypertension was selected for comparison. Inclusion criteria for the control group were: technically adequate study with m-mode measurements to allow calculation of LVMI, no history or documentation of elevated blood pressure, no documented structural abnormalities by previous echocardiography, and no abnormal findings from the current echocardiography study. LVM was calculated using the Devereux equation, LVMI was calculated as LVM/height2.7, and LVH was defined as LVMI ⬎ 51 gm/m2.7. Mean blood pressure (BP), BP load, and BP index (ambulatory BP divided by pediatric ambulatory BP 95th percentile) were calculated. Results: LVMI was greater (41.5 ⫾ 12.0 vs. 32.5 ⫾ 8.1, p⬍0.001), and the prevalence of LVH was higher (27% vs. 0%, p⫽0.001) in hypertensive patients compared to control patients. In the hypertensive patients, LVMI showed the strongest correlation with 24-hour SBP index (r⫽0.46, p⫽0.004) among all demographic and clinical variables analyzed. LVMI also showed significant correlations with 24-hour SBP (r⫽0.34, p⫽0.042), 24-hour SBP load (r⫽0.36, p⫽0.031), sleep SBP (r⫽0.33, p⫽0.048), and sleep SBP load (r⫽0.38, p⫽0.021). LVMI did not correlate significantly with age, weight, clinic BP, or any ambulatory DBP parameters. Hypertensive patients with and without LVH did not differ in age, gender distribution, height, weight, or BMI. Patients with LVH had significantly higher 24-hour SBP (p⫽0.035), sleep SBP (p⫽0.024), and ambulatory SBP index (p⫽0.022) than those without LVH. The prevalence of LVH was 47% (8/17) in patients with both SBP load ⬎ 50% and 24-hour SBP index ⬎ 1.0, compared to 10% (2/20) in patients without these criteria (p⫽0.015). Conclusions: These data demonstrate in hypertensive children that ABPM may be useful for evaluating cardiovascular risk and thereby help determine the need for antihypertensive therapy. Key Words: Child, Ambulatory Blood Pressure, Left Ventricular Hypertrophy
P-476 TREATMENT OF HYPERTENSION WITH RAMIPRIL IN CHILDREN WITH RENAL DISEASES Tomas Seeman, Jiri Dusek, Janusz Feber, Karel Vondrak, Jan Janda. Dept of Pediatrics, University Hospital Motol, Prague, Prague 5, Czech Republic.
Key Words: COZAAR威/losartan, Angiotensin II Receptor Antagonist, Pediatric Hypertension
P-475 AMBULATORY BLOOD PRESSURE MONITORING FOR THE ASSESSMENT OF CARDIOVASCULAR RISK IN HYPERTENSIVE CHILDREN Jonathan Sorof, Gina Cardwell, Tim Poffenbarger, Kathy Franco, Ronald Portman. Pediatrics, University of Texas-Houston Medical School, Houston, TX, United States. Objectives: To determine the ABPM variables most closely associated with LVMI and/or predictive of the presence of LVH in hypertensive
The purpose of the study was to investigate the effect of long-acting ACE-inhibitor ramipril on blood pressure (BP) and proteinuria in children with renal hypertension. We have investigated 15 children and adolescents (mean age 13.7, range 5.0 - 19.8 yrs, 9 girls) with chronic renal diseases (polycystic kidney diseases, glomerulopathies, uropathies) and hypertension. The children have been treated prospectively with ramipril monotherapy for 6 months. BP has been evaluated using ambulatory blood pressure monitoring (ABPM, oscillometric device SpaceLabs 90207). Hypertension was defined as systolic and/or diastolic daytime and/or night-time mean BP ⱖ 95.pc according Soergel et al. (J Pediatr 1997;130:178-184). Proteinuria was measured in 24 hr urine. Glomerular filtration rate (GFR) was assessed using Schwartz formula. Ramipril was given once daily, the starting dose was 1.5 mg/m2/24 hr and this dose was increased after one month if the BP did not dropped below 95.pc. Mean arterial BP decreased in all children after 6 months of ramipril treatment. The mean BP fall was 10.5 and 10.3 mmHg for daytime systolic and daytime diastolic BP resp. and 8.0 and 7.7 mmHg for night-time systolic and night-time diastolic BP resp. In 9 children (60 %) the BP completely normalised (i.e. all BP values ⬍ 95.pc) at the end of