TY - JOUR
T1 - Influence of Age, Heart Failure and ACE Inhibitor Treatment on Plasma Renin Activity in Children
T2 - Insights from a Systematic Review and the European LENA Project
AU - Steichert, Melina
AU - Cawello, Willi
AU - Bajcetic, Milica
AU - Breur, Johannes M.P.J.
AU - Dalinghaus, Michiel
AU - Male, Christoph
AU - De Wildt, Saskia N.
AU - Läer, Stephanie
N1 - Publisher Copyright:
© 2023 Frontiers in Bioscience. All rights reserved.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Plasma renin activity (PRA) has gained relevance as prognostic marker in adults with heart failure. The use of PRA as a clinically meaningful parameter in children and children with heart failure requires a thorough knowledge of the factors that influence PRA to correctly assess PRA levels. We aim to evaluate the influence of age, heart failure and angiotensin-converting enzyme inhibitor (ACEi) on PRA levels in children. Methods: We conducted a systematic literature search to identify studies on PRA levels in healthy children and in children with heart failure. In addition, we analysed PRA data measured before (n = 35, aged 25 days-2.1 years), 4 hours after (n = 34) and within the first 8 days of enalapril treatment (n = 29) in children with heart failure from the European project Labeling of Enalapril from Neonates up to Adolescents (LENA). Results: Age has a profound effect on PRA levels in healthy children, as PRA levels in the literature are up to about 7 times higher in neonates than in older children. Children with heart failure younger than 6 months showed 3-4 times higher PRA levels than healthy peers in both the literature and the LENA studies. In the LENA studies, the ACEi enalapril significantly increased median predose PRA by a factor of 4.5 in children with heart failure after 4.7±1.6 days of treatment (n = 29, p < 0.01). Prior to treatment with enalapril, LENA subjects with symptomatic heart failure (Ross score≥3) had a significantly higher PRA than LENA subjects with asymptomatic heart failure of comparable age (Ross score≤2, p < 0.05). Conclusions: Age, heart failure and ACEi treatment have a notable influence on PRA and must be considered when assessing PRA as a clinically meaningful parameter. Clinical Trial Registration: The trials are registered on the EU Clinical Trials Register (https://www.clinicaltrialsregister.eu). Trial registration numbers: EudraCT 2015-002335-17, EudraCT 2015-002396-18.
AB - Background: Plasma renin activity (PRA) has gained relevance as prognostic marker in adults with heart failure. The use of PRA as a clinically meaningful parameter in children and children with heart failure requires a thorough knowledge of the factors that influence PRA to correctly assess PRA levels. We aim to evaluate the influence of age, heart failure and angiotensin-converting enzyme inhibitor (ACEi) on PRA levels in children. Methods: We conducted a systematic literature search to identify studies on PRA levels in healthy children and in children with heart failure. In addition, we analysed PRA data measured before (n = 35, aged 25 days-2.1 years), 4 hours after (n = 34) and within the first 8 days of enalapril treatment (n = 29) in children with heart failure from the European project Labeling of Enalapril from Neonates up to Adolescents (LENA). Results: Age has a profound effect on PRA levels in healthy children, as PRA levels in the literature are up to about 7 times higher in neonates than in older children. Children with heart failure younger than 6 months showed 3-4 times higher PRA levels than healthy peers in both the literature and the LENA studies. In the LENA studies, the ACEi enalapril significantly increased median predose PRA by a factor of 4.5 in children with heart failure after 4.7±1.6 days of treatment (n = 29, p < 0.01). Prior to treatment with enalapril, LENA subjects with symptomatic heart failure (Ross score≥3) had a significantly higher PRA than LENA subjects with asymptomatic heart failure of comparable age (Ross score≤2, p < 0.05). Conclusions: Age, heart failure and ACEi treatment have a notable influence on PRA and must be considered when assessing PRA as a clinically meaningful parameter. Clinical Trial Registration: The trials are registered on the EU Clinical Trials Register (https://www.clinicaltrialsregister.eu). Trial registration numbers: EudraCT 2015-002335-17, EudraCT 2015-002396-18.
KW - angiotensin-converting enzyme inhibitor
KW - congenital heart disease
KW - dilated cardiomyopathy
KW - enalapril
KW - heart failure
KW - paediatric
KW - plasma renin activity
UR - http://www.scopus.com/inward/record.url?scp=85181625828&partnerID=8YFLogxK
U2 - 10.31083/j.fbl2812335
DO - 10.31083/j.fbl2812335
M3 - Article
C2 - 38179766
AN - SCOPUS:85181625828
SN - 2768-6701
VL - 28
JO - Frontiers in Bioscience - Landmark
JF - Frontiers in Bioscience - Landmark
IS - 12
M1 - 335
ER -