[Treatment of arterial hypertension in children and adolescents--Update of therapeutic options]. / Therapie der arteriellen Hypertonie bei Kindern und Jugendlichen. Aktualisierte Therapieempfehlungen.

Changing living conditions, which lead to physical inactivity and obesity, are probably the main reason for the establishment of risk factors for cardiovascular diseases in children and adolescents. In the past those risk factors were typically seen only in the elderly. On long-term, the elevated body-mass-index is a very important risk factor for primary arterial hypertension in children and adolescents, because it is responsible for both structural and functional changes in the cardiovascular system. Regular screening for these target organ damages is necessary. However, the role of newer methods has still to be proven in current research. The primary therapeutical options for this group are life style interventions like body weight control and physical activity. Children and adolescents with arterial hypertension persisting despite life style interventions should receive medication early, in order to prevent persistent target organ damage. Drug therapy should start as mono therapy--depending on patient profile--with one ACE inhibitor, angiotensin II receptor antagonist, calcium channel blocker or beta-blocker. If blood pressure cannot be reduced into the target area by mono therapy, combination therapy with different mechanisms should be started. Forms of secondary arterial hypertension have to be treated according to the primary disease.

Adult patients with congenital heart disease and pulmonary arterial hypertension: first open prospective multicenter study of bosentan therapy.

BACKGROUND: Endothelin receptor antagonism has been introduced as an effective oral therapy of patients with idiopathic pulmonary arterial hypertension. In view of the pathophysiologic and histologic similarities between idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD), there is a rationale for treating these patients with the oral dual (ET(A)/ET(B)) endothelin receptor antagonist bosentan. METHODS: Thirty-three patients with PAH-CHD (43 +/- 14 years, 23 with Eisenmenger syndrome) were treated with bosentan for a mean of 2.1 +/- 0.5 years. Efficacy was assessed by a panel of tests, including New York Heart Association functional class, 6-minute walking distance, and echocardiographic and hemodynamic parameters. RESULTS: Mean 6-minute walking distance increased from 362 +/- 105 to 434 +/- 68 m (P = .001). New York Heart Association class also improved significantly (3.1 to 2.4, P = .0001). This was associated with slight trends in improvements of transcutaneous oxygen saturation (86% +/- 7% to 88% +/- 7%, P = .13) and maximum oxygen uptake (13.2 +/- 4.0 to 14.9 +/- 2.5, P = .18). Right ventricular systolic pressure measured by echocardiographic decreased from 111 +/- 32 to 106 +/- 22 mm Hg (P = .001). Bosentan treatment was well tolerated by all patients. CONCLUSIONS: Long-term bosentan treatment in adult patients with PAH-CHD was well tolerated and improved functional status as well as exercise capacity. These findings have to be corroborated by controlled studies that are presently ongoing.