Abstract: PUB229
Use of Lisinopril in an Adolescent with "Extreme Dipper" Autonomic Hypertension Profile
Session Information
Category: Pediatric Nephrology
- 1700 Pediatric Nephrology
Author
- Shah, Siddharth A., University of Louisville, Louisville, Kentucky, United States
Introduction
The interaction between renin angiotensin aldosterone system and autonomic nervous system for blood pressure (BP) control is described. Angiotensin type-1 receptor activation in hypothalamus increases activity of paraventricular pre-sympathetic neurons as well as increases permeability of blood brain barrier to angiotensin. ADHD stimulant medication may be associated with cardiac autonomic dysfunction in children. Standard deviation (SD) of systolic BP (SBP) may be a better measure to study autonomic BP pattern particularly with nightime extreme dipper hypertensive profile.
Case Description
A 16-year-old non obese male presents with hypertensive urgency; BP of 168/102 mm Hg and symptoms of headache and vomiting. He was maintained on stimulant medication for ADHD that was stopped at initial presentation. The evaluation of secondary causes of hypertension was negative. He was started on Ca channel blocker. Four months after initial presentation, the 24-hour ambulatory BP monitoring (ABPM) study was done that showed hypertensive profile with extreme nighttime dipping. SD of SBP was high at 24.29 suggesting significant BP fluctuations (Figure-1). He was started on Lisinopril at the dose of 20 mg daily. ABPM study was repeated 3 months latter (Figure-2). There was marked improvement in daytime BP fluctuations (daytime SD of SBP-8.48) without worsening nightime BP dipping. Dizziness on changing posture was not reported.
Discussion
ACE inhibitors may be considered as an option for treatment of autonomic hypertension in adolescents with extreme nighttime dipping BP profile.