Angiotensin II Receptor Blockers

Abstract

Background: The incidence of hypertension in the pediatric population has been increasing. Childhood blood pressure is predictive of adult BP. The renin angiotensin aldosterone system pathway is important in the mediation of pediatric hypertension. New therapies approved for adults are often used off label in children with little or no efficacy and safety data in the paediatric population The angiotensin receptor blockers has been shown to be effective and safe in the treatment of pediatric hypertension.Objective: The objective of this review is to highlight available clinical evidence on the efficacy, safety tolerability and kinetics of angiotensin receptor blockers in childhood hypertension and its antiproteinuric effect in renal disease. Method: The search strategy was based on Pubmed, Medline database, Cochrane Library, manual, Google and Yahoo searches. We summarized ten randomized controlled trials (RCTs .The search was done in June 2014 and updated in January and May 2015 in English language . Results: A total of 120 publications were accessed from which 68 references were included in the review. The design and outcome of ten key randomised trials are summarised. Randomised trials have demonstrated the efficacy of angiotensin receptor blockers in the pediatric population aged 1-16 years. This class of drugs reduce blood pressures in pediatric patients with hypertension and proteinuria in renal disease. Safety pharmacokinetic, dosage, and palatability of adult formulations for the paediatric age group are highlighted Conclusion: Angiotensin receptor antagonists are useful effective and safe alternatives to available antihypertensive therapy in paediatric population. Angiotensin receptor antagonists should however be prescribed cautiously for sexually active adolescent females due to concern about angiotensin receptor blocker fetopathy.

Angioedema: Clinical and Etiological Aspects

“…Because of the increasing of ACEI use in this era, many studies reported an increase in ACEI-induced angioedema which had been reported to occur in 0.1–0.5% of patients taking these drugs [ 11 ]. Megerian et al reported that between 1985 and 1990, 35% of patients presenting with angioedema were using ACEI [ 12 ].…”

Long-term use and tolerability of irbesartan for control of hypertension

“…So far, seven angiotensin receptor blockers have been approved by the US Food and Drug Administration, with slightly different therapeutic indications (Table 1). In comparison with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers have very similar antihypertensive efficacy, but a better side effect profile, mainly because they are not associated with cough, a major side effect of ACE inhibitors 3,4. Several angiotensin receptor blockers have a long plasma half-life and binding time to the AT1 receptor, enabling a once a day administration.…”

Sitagliptin-Associated Angioedema

“…ARBs may increase bradykinin levels similar to ACE inhibitors (5). We speculate that in our patient the initiation of the DPP-IV inhibitor sitagliptin in the background of the concurrent administration of ARB losartan may have resulted in angioedema.…”