Efficacy and safety of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for IgA nephropathy in children.

BACKGROUND: IgA nephropathy (IgAN) is one of the most prevalent primary glomerulopathies in children. There are various studies investigating the efficacy of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in adults with IgAN. However, only few studies evaluated the efficacy of these medications in pediatric patients. OBJECTIVE: To evaluate the efficacy and safety of ACEI/ARB in children with IgAN. DATA SOURCES: Databases including PubMed, Web of Science, Cochrane, Scopus, and Google Scholar were searched between the 1st of April and 20th of July of 2021 using the keywords "IgA Nephropathy," "Berger's Disease," "Angiotensin-Converting Enzyme Inhibitors," "Angiotensin Receptor Antagonists," "Angiotensin II Type 1 Receptor Blockers," and similar entry terms collected from the Medical Subject Headings (MeSH). STUDY ELIGIBILITY CRITERIA: Observational studies (case series, case-control, cohort, and cross-sectional) and clinical trials with descriptions of pediatric patients (under 19 years old) with histopathological diagnosis of IgA nephropathy and who received ACEI and/or ARB. PARTICIPANTS AND INTERVENTIONS: Pediatric patients (under 19 years old) with histopathological diagnosis of IgA nephropathy and who received ACEI and/or ARB. STUDY APPRAISAL: For quality assessment, the Risk of Bias 2 tool (RoB 2), the Risk Of Bias In Non-randomized Studies of Interventions tool (ROBINS-I), the National Institutes of Health (NIH) quality assessment tool, and the Newcastle-Ottawa Scale (NOS) were used. RESULTS: After recovering 1,471 studies, only eight, published between 2003 and 2019, met the eligibility criteria and were included in this systematic review. Of the 737 included children in the studies, 202 (25.8%) used ACEI/ARB and were compared with placebo and other therapy regimens. Of the seven studies that evaluated proteinuria, six reported an efficacy of ACEI/ARB in reducing this marker. ACEI/ARB also showed a possible effect in reducing hematuria and oxidative stress. The most common side effect was dizziness. LIMITATIONS: The number of studies about the treatment with ACEI/ARB in children with IgAN is scarce. In addition, the studies are very heterogeneous. There are few studies that compared ACEI/ARB with placebo. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The use of ACEI and/or ARB appears to be safe and to reduce proteinuria in pediatric patients with IgAN. Nonetheless, further randomized controlled trials, with greater methodological rigor and longer follow-up time, are required to establish the efficacy and safety of this therapy in this population. SYSTEMATIC REVIEW REGISTRATION NUMBER: The protocol of this systematic literature review was registered in PROSPERO under the number CRD42021245375, and in the OSF registries ( https://osf.io/qft4z/ ) with the registration https://doi.org/10.17605/OSF.IO/VADYR . A higher resolution version of the Graphical abstract is available as Supplementary information.

Hipertensão arterial e insuficiência cardíaca: análise crítica dos novos fármacos / Arterial hypertension and heart failure: critical analysis of new drugs

A insuficiência cardíaca (IC) permanece como uma das maiores causas de hospitalização e mortalidade dentre todas as doenças, sendo a hipertensão arterial um dos mais importantes fatores de risco para o seu desenvolvimento. Em virtude da relevância e prevalência dessa doença, um número recorde de estudos comparativos, além de novas classes terapêuticas, tem sido desenvolvido nos últimos anos para garantir ao médico maior flexibilidade no tratamento do seu paciente, com a finalidade de frear a progressão do remodelamento ventricular e reduzir a internação hospitalar, bem como os desfechos cardiovasculares. Nesse intuito, o presente artigo avalia diversas meta-análises recentemente publicadas, as quais comparam IECAs aos BRAs e indicam um melhor prognóstico associado aos IECAs na redução de mortalidade total e cardiovascular, provavelmente devido ao efeito adjuvante da bradicinina como cardioprotetor. No entanto, os BRAs ganharam novo destaque a partir de sua associação ao sacubitril, reduzindo eventos cardiovasculares como reinternação por IC e morte cardíaca quando comparados a um IECA. Este artigo de revisão busca realizar uma análise crítica todas as classes de anti-hipertensivos com função na IC, com base na evidência científica mais recente, discorrendo sobre seus mecanismos de proteção cardiovascular e de seus resultados na redução da morbimortalidade cardíaca

Heart Failure (HF) remains as one of the most important causes of both hospitalization and mortality among all diseases, with hypertension being one of the major factors of risk for its development. As a result of the relevance and prevalence of this disease, a record number of comparative studies, apart from new pharmacological classes, have been developed in the last few years to provide more flexibility to physicians on the process of choosing a proper treatment for patients, for the purpose of slowing ventricular remodeling and reducing hospitalization, as well as cardiovascular outbreaks. Within this context, the present study has examined recently published meta- analysis, which compared ACEi and ARBs, and indicates better prognosis of ACEi in the reduction of all- -cause mortality and cardiovascular mortality, probably due to the effect of bradykinin as a cardioprotector. However, it is important to acknowledge that ARBs have gained new emphasis since it was associated with sacubitril, reducing cardiovascular events such as hospitalization for HF and cardiovascular death when compared to ACEi. This current revision article seeks to accomplish a critical analysis of all classes of antihypertensives that act on heart failure by analyzing the most recent scientific evidence, discoursing about its mechanisms of cardiovascular protection and its results in the reduction of cardiovascular mortality