Captopril to Lisinopril Conversion in Pediatric Cardiothoracic Surgery Patients Less Than 7 Years of Age (RISE-7)

• Published in: Pediatric cardiology Vol. 45; no. 2; pp. 394 - 400
• Main Authors: Bransetter, Joshua W., Anderson, McKenzie, Zaki, Hania, Gleason, Michelle E., Beshish, Asaad G.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2024
• Subjects: Cardiac Surgery; Cardiology; Medicine; Medicine & Public Health; Vascular Surgery; Hypertension; Pediatrics; Cardiothoracic surgery; Lisinopril; Captopril
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-023-03373-w

Hypertension after cardiothoracic surgery is common, often requiring pharmacologic management. The recommended first-line antihypertensives in pediatrics are angiotensin converting enzyme inhibitors. Captopril and enalapril are approved for infants and children; however, lisinopril is only approved for > 7 years of age. This study evaluated safety and efficacy of converting from captopril to lisinopril in patients utilizing a pre-defined conversion of 3 mg captopril to 1 mg lisinopril. This was a single center, retrospective study including patients less than 7 years of age admitted for cardiothoracic surgery who received both captopril and lisinopril from 01/01/2017 to 06/01/2022.The primary outcome was mean change in systolic blood pressure (SBP) from baseline for 72 h after conversion of captopril to lisinopril. A total of 99 patients were enrolled. There was a significant decrease in mean SBP (99.12 mmHg vs 94.86 mmHg; p  = 0.007) with no difference in DBP (59.23 mmHg vs 61.95 mmHg; p  = 0.07) after conversion to lisinopril. Of the 99 patients who were transitioned to lisinopril, 79 (80%) had controlled SBP, 20 (20%) remained hypertensive, 13 (13%) received an increase in their lisinopril dose, and 2 (2%) required an additional antihypertensive agent. There was a low overall rate of AKI (3%) and hyperkalemia (4%) respectively. This study demonstrates that utilizing lisinopril with a conversion rate of 3 mg of captopril to 1 mg of lisinopril was safe and effective for controlling hypertension in pediatric patients following cardiothoracic surgery.