Racial Difference in Blood Pressure Response to Angiotensin-Converting Enzyme Inhibitors in Children: A Meta-Analysis

Angiotensin-converting enzyme (ACE) inhibitors are frequently used to treat hypertension in children ( 1 ). ACE inhibitors alter the balance between the vasoconstrictive, salt-retentive, and cardiac hypertrophic properties of angiotensin II and the vasodilatory and natriuretic properties of bradykinin; they also alter the metabolism of other vasoactive substances ( 2 ). Through these mechanisms, ACE inhibitors decrease systemic vascular resistance and promote natriuresis without increasing heart rate. They have proven efficacy in the treatment of hypertension, congestive heart failure, and left ventricular dysfunction and also delay the progression of diabetic nephropathy ( 2 ). In adults, ACE inhibitors are less potent in blacks than in whites ( 3 , 4 ). Although racial differences in response to ACE inhibitors are established in adults, data in children are limited by small sample sizes of individual trials ( 5 , 6 ). We evaluated results of 6 trials of ACE inhibitors submitted to the US Food and Drug Administration (FDA) for pediatric exclusivity using meta-analytic techniques to estimate the effect of race on blood pressure response.