Congenital Adrenal Hyperplasia in Children: The Relationship between Plasma Renin Activity and Hypertension

• Published in: Iranian journal of medical sciences Vol. 49; no. 6; pp. 377 - 383
• Main Authors: Lubis, Siska Mayasari, Soesanti, Frida, Hidayati, Eka Laksmi, Aap, Bambang Tridjaja
• Format: Journal Article
• Language: English
• Published: Iran Shiraz University of Medical Sciences 01.06.2024
• Subjects: Adolescent; adrenal hyperplasia, congenital; Adrenal Hyperplasia, Congenital - blood; Adrenal Hyperplasia, Congenital - complications; Adrenal Hyperplasia, Congenital - drug therapy; Adrenal Hyperplasia, Congenital - physiopathology; Adrenogenital syndrome; Child; Child, Preschool; Clinics; Cross-Sectional Studies; Ethylenediaminetetraacetic acid; Female; Fludrocortisone; Fludrocortisone - therapeutic use; Genetic disorders; Humans; hydrocortisone; Hydrocortisone - analysis; Hydrocortisone - blood; Hydrocortisone - therapeutic use; Hydroxyprogesterone; Hyperplasia; Hypertension; Hypertension - blood; Indonesia - epidemiology; Infant; Male; Original; Pediatrics; Renin - blood; Indonesia; Hypertension; Hydrocortisone; Adrenal hyperplasia, congenital
• ISSN: 0253-0716; 1735-3688; 1735-3688
• DOI: 10.30476/ijms.2023.98508.3058

Children with Congenital Adrenal Hyperplasia (CAH) have a higher chance of hypertension. The likelihood of hypertension is higher in CAH children who get fludrocortisone medication and have an over-suppression. Plasma renin activity (PRA) is a sensitive indicator when the fludrocortisone dose is insufficient. The objective of this study is to assess the relationship between plasma renin activity with hypertension in 21-hydroxylase-deficient (21-OHD) CAH children. This cross-sectional observational analytical study was conducted in 2019 at the Pediatric Endocrinology Outpatient Clinic in Dr. Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia. The subjects were 21-OHD CAH children, aged >6 months to 18 years who had already taken hydrocortisone with or without fludrocortisone for at least 6 months, and were divided into hypertension and non-hypertension groups. The subjects were selected by a consecutive sampling method. Data was analyzed using SPSS software (version 23.0) with unpaired test analysis and multiple logistic regression test. Statistical significance was achieved if P<0.05. Forty 21-OHD CAH patients were included, and 20 subjects (50%) had hypertension. A higher incidence of hypertension was found in salt-wasting CAH than in simple virilizing types (59.3% vs 30.8%). There was a significant mean difference in PRA levels between hypertension and non-hypertension groups in salt-wasting patients (P=0.016). A significant difference between the last dose of hydrocortisone with the number of hypertension patients in salt-wasting patients (P=0.032) was found, and low PRA levels showed a 1.09 times higher risk of hypertension. Children with salt-wasting CAH with low PRA levels had a higher risk of getting hypertension.