Intensive Blood Pressure Control Slows Progression of Chronic Kidney Disease in Children

Hypertension and an unregulated renin-angiotensin system have known adverse effects on progression of chronic kidney disease in adults, but data in children are lacking. In an international study, researchers randomized 385 children (age range, 3–18 years) with chronic kidney disease to intensive blood pressure (BP) control (24-hour mean arterial pressure <50th percentile for age) or standard BP control (mean arterial pressure, 50th to 95th percentile) using a fixed high dose of the angiotensin-converting–enzyme (ACE) inhibitor ramipril (6 mg/m² body surface daily) plus additional antihypertensives, if needed.

After 5 years, significantly fewer children in the intensive BP-control group than in the standard BP-control group reached the primary endpoint of 50% decline in glomerular filtration rate (GFR) or progression to end-stage renal disease (30% vs. 42%; hazard ratio, 0.65). The renoprotective effect of intensive BP control persisted after adjustment for covariates and was greater in children with glomerulopathies than in children with hypoplasia-dysplasia renal disease. In both groups, mean proteinuria decreased during the first 6 months but, despite good BP control, gradually returned to baseline levels during the following 36 months.