Atenolol vs enalapril in young hypertensive patients after successful repair of aortic coarctation.
Late arterial hypertension has been identified as a major predictor for morbidity and mortality in aortic coarctation (AoC) patients. Few data are available about efficacy and tolerability of angiotensin converting enzyme inhibitors vs beta-blockers in young AoC patients. This study aimed to evaluate the tolerability and efficacy on 24-h blood pressure (BP) and left ventricular mass/height(2.7) (LVMI), of atenolol vs enalapril. We enrolled consecutive AoC hypertensive patients with (a) no history of BP treatment or after >48 h of withdrawn, (b) aged 6-20 years, (c) body mass index (BMI) <90th percentile for age and sex, (d) >12 months from a successful AoC repair and (e) no major associated cardiovascular abnormalities. All patient were evaluated with 24-h ambulatory BP monitoring, standard echocardiography, strain-strain rate imaging, at enrolment, 3, 6 and 12 months of treatment. We studied 51 AoC patients (13±3.9 years, BMI: 21.4±4.3 kg m(-2)). Patients were randomly assigned at atenolol treatment (n=26), or enalapril treatment (n=25). The mean follow-up duration was 11±2 months. Both drugs were able to significantly reduce 24-systolic BP (SBP; atenolol: 133±11 mm Hg vs 124±16 mm Hg, P=0.016; enalapril: 135±6 mm Hg vs 127±7 mm Hg, P=0.001). Only enalapril was able to significantly reduce LVMI (47±12  vs 39.6±10 g m(-)(2.7), P=0.016). Only in atenolol group in two cases (7.7%) drug withdrawal was needed because of adverse events. Enalapril and atenolol are similarly effective in reducing SBP. However, only enalapril demonstrated a significant reduction of LVMI. In no case, enalapril was stopped because of adverse events.
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
G
G
Di Salvo
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
B
B
Castaldi
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
S
S
Gala
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
L
L
Baldini
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
F
F
Del Gaizo
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
F A
FA
D'Aiello
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
A
A
Mormile
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
A
A
Rea
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
G
G
Scognamiglio
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
G
G
Pacileo
King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Saudi Arabia.
S
S
Keating
King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Saudi Arabia.
B M
BM
Fadel
Nephrology Department, Second University of Naples, Naples, Italy.
L
L
Berrino
Pharmacology Department, Second University of Naples, Naples, Italy.
A
A
Perna
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
M G
MG
Russo
Pediatric Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
R
R
Calabrò
D000293:Adolescent; D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001262:Atenolol / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D006348:Cardiac Surgical Procedures; D002648:Child; D004656:Enalapril / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007558:Italy; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D058671:Adrenergic beta-1 Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001262:Atenolol; D004656:Enalapril