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

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Abstract

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.

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The authors did not receive support or funding from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Pharmacy, Children’s Healthcare of Atlanta, 1405 East Clifton Rd. Northeast, Atlanta, GA, 30322, USA

    Joshua W. Bransetter & Hania Zaki

  2. Department of Pharmacy, University of Tennessee Health Science, Knoxville, TN, USA

    McKenzie Anderson

  3. Children’s Healthcare of Atlanta, Heart Center Admin, Atlanta, GA, USA

    Michelle E. Gleason

  4. Division of Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA

    Asaad G. Beshish

Authors
  1. Joshua W. Bransetter
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  2. McKenzie Anderson
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  3. Hania Zaki
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  4. Michelle E. Gleason
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  5. Asaad G. Beshish
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Contributions

JB and MA wrote the main manuscript text, and did the data collection. HZ and AB participated in project conceptualization and development, and performed final review of the manuscript. MG provided final review of the manuscript, performed statistical analysis of the collected data, and prepared table 1, and figures 1 and 2.

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Correspondence to Joshua W. Bransetter.

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Bransetter, J.W., Anderson, M., Zaki, H. et al. Captopril to Lisinopril Conversion in Pediatric Cardiothoracic Surgery Patients Less Than 7 Years of Age (RISE-7). Pediatr Cardiol 45, 394–400 (2024). https://doi.org/10.1007/s00246-023-03373-w

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  • DOI: https://doi.org/10.1007/s00246-023-03373-w

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