USE OF SARALASIN IN THE DIAGNOSTIC EVALUATION OF HYPERTENSION IN CHILDREN

Abstract

Saralasin (S), a competetive antagonist of angiotensin II, has been used to evaluate renin-angiotensin dependent hypertension in adults. The purposes of this study were to determine 1) if S might be useful in the evaluation of hypertension in children and 2) if it would provide information about the involvement of the renin-angiotensin system in various forms of hypertension in the young. An IV infusion of S (0.4 to 0.8mg/min) was given to 21 children (4 to 18 years) with sustained hypertension (mean admission BP=162/114). All pats had complete diagnostic evaluation including renal arteriography. Pats were divided into 3 groups: hypertension secondary to renal parenchymal disease (RPH), reno-vascular hypertension (RVH) and essential hypertension (EH). The S test was considered to be positive when systolic BP decreased 10mmHg and diastolic BP decreased 6mmHg. A positive S test was obtained in 4 of 8 pats with RPH, 4 of 7 pats with RVH and 1 of 6 pats with EH. All pats with a positive S test had increased peripheral renin activity (PRA). Two pats with EH and 1 with RVH had increased PRA but negative S tests.. Four pats with RPH (3+ and 1-S test) and all 7 pats with RVH have had a surgical procedure to help control their hypertension. These results suggest that S may be useful in the diagnostic evaluation of hypertension in children. More experience and time are required to determine whether S can help predict surgical success for RVH and RPH in the young.