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Efficacy and safety of angiotensin II receptor type 1 antagonists in children and adolescents

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Abstract

Our purpose was to evaluate the effects of angiotensin II receptor type 1 antagonists (ARAs) in children and adolescents with hypertension or/and several kinds of nephropathies on blood pressure (BP) and proteinuria and to evaluate related safety issues. Data sources were Medline, Embase, The Cochrane Library, BIOSIS Previews, contact with investigators and manufacturers, personal bibliography of the lead author, and manual searches. We selected randomized controlled trials (RCTs), uncontrolled trials, and case series investigating ARAs in children and adolescents, as well as case reports about adverse events and the embryotoxic effects of ARAs in children. In four RCTs with 698 individuals, mean systolic blood pressure (BP) decreased by 10.5 mmHg [95% confidence interval (CI) 9.8−11.2] and mean diastolic BP by 6.4 mmHg (95% CI 5.8−7.0). Proteinuria decreased by 30−64% (range) in two RCTs and four case series. Safety data were comparable with adult safety data. ARAs can be considered effective and safe in lowering BP and proteinuria in the pediatric age group. The correlation between the surrogate parameters BP and proteinuria with clinical end points is documented to a large degree. The evidence is based on RCTs and also on lower evidence levels, such as case series. In some conditions, RCTs in children are not feasible. Registers could provide more evidence in the future.

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Acknowledgements

We thank Dr. Ilona Rhode for her assistance with the literature search in Medline, Tobias Kaiser for the graphic design of the figures, and Dr. Walter Lee for his valuable help in proofreading the manuscript.

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Authors and Affiliations

  1. Department of Pharmacy, Philipps University Marburg, Marburg, Germany

    Siegtraut Dorothea Herder & Hartmut Morck

  2. Formerly: Department of Biostatistics, University Heidelberg, Heidelberg, Germany

    Ernst Weber

  3. General Practitioner in private practice, Siegen, Germany

    Almuth Winkemann

  4. Pediatrician in private practice, Siegen, Germany

    Christoph Herder

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  1. Siegtraut Dorothea Herder
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Correspondence to Siegtraut Dorothea Herder.

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Herder, S.D., Weber, E., Winkemann, A. et al. Efficacy and safety of angiotensin II receptor type 1 antagonists in children and adolescents. Pediatr Nephrol 25, 801–811 (2010). https://doi.org/10.1007/s00467-009-1346-z

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