title: Better renoprotective effect of angiotensin II antagonist compared to dihydropyridine calcium channel blocker in childhood.
abstract: BACKGROUND
  The dihydropyridine calcium channel blocker amlodipine and the angiotensin II antagonist irbesartan effectively reduce blood pressure in hypertensive children.
  
  
  METHODS
  Eligible for the open-label, randomized study were nephropathic children between 6.0 and 18 years of age with plasma creatinine <177 micromol/L, overt proteinuria, untreated arterial hypertension (systolic, 5 to 30 mm Hg; and diastolic, 1 to 15 mm Hg;>95th centile) and stable immunosuppressive treatment. The initial dose of amlodipine was 5 mg (body weight, 20 to 40 kg) and 10 mg (body weight,>40 kg), respectively, that of irbesartan, which was 75 mg (body weight, 20 to 40 kg) and 150 mg (body weight,>40 kg), respectively. The dosage was doubled if necessary.
  
  
  RESULTS
  A total of 26 children aged 6.1 to 17 years were allocated to receive either amlodipine (N = 13) or irbesartan (N = 13) for 16 weeks. Severe edema and headache occurred in two patients on amlodipine who withdrew from the study. No adverse experiences were noted in patients given irbesartan. Amlodipine [by 12 (10 to 14)/7 (5 to 10) mm Hg; median and interquartile range, respectively] and irbesartan [by 13 (9 to 16)/9 (7 to 11) mm Hg, respectively] reduced blood pressure (P < 0.01) in a similar fashion. Heart rate, plasma sodium, and creatinine did not change. Irbesartan slightly increased plasma potassium [by 0.1 (0.0 to 0.2) mmol/L; P < 0.05]. Plasma albumin and the urinary albumin/creatinine ratio were similar before and with amlodipine. On the contrary, irbesartan increased plasma albumin [by 4 (3 to 5) g/L; P < 0.03] and decreased the urinary albumin/creatinine ratio [by 242 (68 to 312) mg/mmol; P < 0.03].
  
  
  CONCLUSIONS
  The study demonstrates that in children the effect of angiotensin II antagonists on proteinuria is better than that of dihydropyridine calcium channel blockers.
authors.affiliation: Division of Nephrology, University Children's Hospital, Inselspital, Bern, Switzerland.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Gartenmann
authors.forename: Emilio
authors.initials: E
authors.lastname: Fossali
authors.forename: Rodo O
authors.initials: RO
authors.lastname: von Vigier
authors.forename: Giacomo D
authors.initials: GD
authors.lastname: Simonetti
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidtko
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.forename: Mario G
authors.initials: MG
authors.lastname: Bianchetti
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000652:urine; D017311:Amlodipine / Q000009:adverse effects / Q000627:therapeutic use*; D000804:Angiotensin II / Q000037:antagonists & inhibitors*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D003404:Creatinine / Q000652:urine; D019610:Cytoprotection; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D000077405:Irbesartan; D007668:Kidney / Q000187:drug effects*; D008297:Male; D012709:Serum Albumin / Q000378:metabolism; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D002121:Calcium Channel Blockers; D012709:Serum Albumin; D013777:Tetrazoles; D000804:Angiotensin II; D017311:Amlodipine; D003404:Creatinine; D000077405:Irbesartan