Real-world evidence of lisinopril in pediatric hypertension and nephroprotective management: a 10-year cohort study.

Background: Over the last 20 years, pediatric hypertension (pHTN) prevalence in Western society has risen from 3.5 to 9% due to childhood overweight, obesity, and secondary kidney and cardiological conditions. Few studies have assessed commonly used antihypertensive medication lisinopril's (ACE-inhibitor) long-term efficacy and the long-term value of renin-angiotensin-aldosterone system (RAAS) biomarkers.

Methods: This is a retrospective cohort study at Ghent University Hospital, Belgium, with 106 young patients (1-18 years) treated with lisinopril due to hypertension (HTN) and chronic kidney disease (CKD) assessed for treatment outcomes against clinical benchmarks over 10 years.

Results: Lisinopril was mainly initiated for secondary hypertension or nephroprotection (89%) due to kidney causes. A starting dose across groups was lower than 0.07 mg/kg for 48% (n = 50). HTN patients without CKD achieved systolic blood pressure below the 95th percentile within 2 years, but efficacy declined after 2.5 years. CKD patients maintained a steady response, reaching systolic targets by 40 months and showing improved diastolic control over 70 months. Proteinuria reduction had a median urine protein creatinine ratio (UPCR) to 0.57 g/g at 6 months, with a reappearance of UPCR 2 g/g creatinine after 40 months. Aldosterone breakthrough occurred from 6 months onward in all groups. Over 70 months, aldosterone and aldosterone-renin-ratio (ARR) progression significantly differ between children with and without normal kidney function.

Conclusions: Treatment efficacy for systolic blood pressure in hypertensive patients with abnormal kidney function diminishes after 2.5 years and for proteinuria in children after 3 years, highlighting the need for dosage recalibration according to guidelines and/or the need for alternative treatments.