Abstract
The renin-angiotensin-aldosterone system (RAAS) plays a major role in the regulation of blood pressure and homeostasis. Therefore, it is a commonly used target for pharmacotherapy of cardiovascular diseases in adults. However, the efficacy of this pharmacotherapy can only be limitedly derived into children. Comprehensive knowledge of the humoral parameters acting in the paediatric RAAS (e.g. angiotensin I, angiotensin II, angiotensin 1–7, angiotensin III, and angiotensin IV) might facilitate a more effective and rational pharmacotherapy in children. Therefore, this review aims to provide an overview of the maturing RAAS. Out of 925 identified records, 35 publications were classified as relevant. Physiological and pathophysiological concentrations of angiotensin peptides were compiled and categorised according to European Medicines Agency age groups. Age has a major impact on circulating angiotensin I, angiotensin II, and angiotensin 1–7, which is reflected in an age-dependent decrease during childhood. In contrast to data obtained in adults, no gender-related differences in angiotensin levels were identified. The observed increase in peptide concentrations regarding cardiac- and renal-diseased children is influenced by surgical repair, while evidence for a pharmacological impact is conflicting. A comprehensive set of angiotensin I, angiotensin II, and angiotensin 1–7 values from neonates up to adolescents was compiled. Indicating age as a strong effector. However, evidence about potential promising targets of the RAAS like angiotensin III and angiotensin IV is still lacking in children.
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Abbreviations
- ACEi:
-
Angiotensin-converting enzyme inhibitor
- AGA:
-
Appropriate for gestational age
- ANCS:
-
Antenatal corticosteroids
- Ang:
-
Angiotensin
- ASD:
-
Atrial septal defect
- BDG:
-
Bidirectional Glenn
- CCB:
-
Calcium channel blocker
- CRF:
-
Chronic renal failure
- CVD:
-
Cardiovascular disease
- ELISA:
-
Enzyme-linked immunosorbent assay
- EMA:
-
European Medicines Agency
- ESRD:
-
End-stage renal disease
- GA:
-
Gestational age
- HPLC:
-
High-pressure liquid chromatography
- HUT:
-
Head-up tilt
- IQR:
-
Interquartile range
- LENA:
-
Labeling of enalapril up to adolescents
- MLBW:
-
Moderate-low birthweight
- NBW:
-
Normal birthweight
- RAAS:
-
Renin-angiotensin-aldosterone system
- RF:
-
Renal failure
- RIA:
-
Radioimmunoassay
- SD:
-
Standard deviation
- SE:
-
Standard error
- SGA:
-
Small for gestational age
- SRINS:
-
Steroid-resistant idiopathic nephrotic syndrome
- UV/VIS:
-
Ultraviolet/visible spectroscopy
- VLBW:
-
Very low birthweight
- VSD:
-
Ventricular septal defect
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Acknowledgements
We thank Jutta Tins for the assistance in double-checking the data and Prof. Dr. Stephanie Laeer for conceptual support.
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Conception and design of the work were developed in close collaboration by Suessenbach FK and Burckhardt BB. Data collection and analysis were performed by Suessenbach FK. The interpretation and drafting of the article were done by Suessenbach FK and Burckhardt BB. Critical revision and final approval of the version to be published were given by Burckhardt BB.
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Suessenbach, F.K., Burckhardt, B.B. Levels of angiotensin peptides in healthy and cardiovascular/renal-diseased paediatric population—an investigative review. Heart Fail Rev 24, 709–723 (2019). https://doi.org/10.1007/s10741-019-09797-y
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DOI: https://doi.org/10.1007/s10741-019-09797-y