Strict blood pressure control to slow progression of renal failure in children

[kkmalaysia]

In the treatment of adults with chronic kidney disease, control of blood pressure is important, and inhibitors of the renin-angiotensin system are the favoured drugs.

Children constitute <1% of people with chronic kidney disease, but 50% of children with such disease are hypertensive. The benefits of strict blood pressure control in children with chronic kidney disease have been demonstrated in an international trial.

A total of 385 children with chronic kidney disease were randomized to intensive blood pressure control (target mean arterial pressure <50th percentile) or conventional control (target mean arterial pressure 50th–95th percentile). They were all treated with ramipril, 6 mg/m2 body surface area/day and non-renin-angiotensin-targeting drugs were added as necessary to achieve blood pressure control. Over an average follow-up of 5 years progression of kidney disease (end-stage renal failure or 50% or greater decline in renal function) occurred in 30% (intensive control) vs 42% (conventional control), a significant 35% risk reduction in the intensive control group. Adverse events were similar in the two groups.

Better blood pressure control delayed progression of kidney disease in children.

The ESCAPE trial group. Strict blood-pressure control and progression of renal failure in children. NEJM 2009; 361:1639–1650; Ingelfinger JR. Blood-pressure control and delay in progression of kidney disease in children. Ibid: 1701–1703 (editorial).