Trial reportJournal of the American Heart Association2016
Angiotensin-Converting Enzyme Inhibitor Initiation and Dose Uptitration in Children With Cardiovascular Disease: A Retrospective Review of Standard Clinical Practice and a Prospective Randomized Clinical Trial.
Trial report in Journal of the American Heart Association, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT00742040 (Rapid Versus Prolonged Inpatient Up-Titration of Captopril), which is not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Rapid Versus Prolonged Inpatient Up-Titration of Captopril: A Randomized Clinical Trial
Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Crowdsourcing the Citation Screening Process for Systematic Reviews: Validation Study.Journal of medical Internet research · 2019Pooled it
- Effect and safety of treatment with ACE-inhibitor Enalapril and β-blocker metoprolol on the onset of left ventricular dysfunction in Duchenne muscular dystrophy - a randomized, double-blind, placebo-controlled trial.Orphanet journal of rare diseases · 2019Trial
- Tailoring Therapy to Bronchopulmonary Dysplasia Phenotype: A Ten-Year Experience in Precision Medicine.Children (Basel, Switzerland) · 2026Article
- Congenital Heart Disease: The State-of-the-Art on Its Pharmacological Therapeutics.Journal of cardiovascular development and disease · 2022Review
- Recent and Upcoming Drug Therapies for Pediatric Heart Failure.Frontiers in pediatrics · 2021Review
- Understanding the early mortality benefit observed in the PARADIGM-HF trial: considerations for the management of heart failure with sacubitril/valsartan.Vascular health and risk management · 2020Review
- ACE inhibition for severe bronchopulmonary dysplasia - an approach based on physiology.Physiological reports · 2018Article
Corrections and comments
- Erratum issued
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAngiotensin-converting enzyme inhibitors (ACEIs) are a mainstay of medical management in pediatric cardiology. However, there are no data defining how best to initiate and uptitrate the dose of these medications in children. METHODS AND
resultsRetrospective chart review revealed only 24% of our pediatric cardiology inpatients were discharged on predefined optimal doses of ACEIs and few underwent further dose uptitration in the 8 weeks after hospital discharge. Therefore, 2 alternative protocols for initiation of captopril were compared in a prospective randomized clinical trial. A "rapid uptitration" protocol reached an optimal dose on day 3, whereas the alternative, "prolonged uptitration" protocol, reached an optimal dose on day 9. Forty-6 patients (54% male) were recruited to the trial, with a median age of 0.7 year (IQR 0.5-2.3 years). Captopril was initiated while in intensive care in 39% of patients and on the cardiology ward in 61%. There were no differences between the protocols in episodes of hypotension, symptomatic hypotension, or indices of renal function. Patients following the rapid protocol reached higher doses of captopril (0.93±0.24 versus 0.57±0.38 mg/kg per dose, P<0.0001) and were more likely to have achieved the predefined target (88% versus 43%, P=0.002) and optimal ACEI doses (80% versus 29%, P=0.001) before discharge.
conclusionsA protocol of rapid ACEI dose uptitration for infants and children with cardiovascular disease can be introduced safely, even in patients receiving intensive care therapy. Compared with standard clinical practice or with a more prolonged protocol, rapid ACEI dose uptitration achieves a higher dosage in this population with no evident disadvantages. CLINICAL
trial registrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT00742040.
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