Managing the risks of antihypertensive agents

Antihypertensives, as well as of course all other drugs, should be used cautiously in pediatric populations and in pregnant women. But ACE inhibitors are a special concern in pregnant women, explained William Cooper, MD, MPH, of Vanderbilt Children’s Hospital of Nashville, Tenn.

The drug class carries black box warnings of fetal renal damage when used in the second or third trimester, Cooper said. A recent cohort study found an elevated risk for fetal malformations with ACE inhibitor use during the first trimester, as well.

Cooper used Tennessee Medicaid data to study 29,507 mother/infant pairs between 1985 and 2000. He found 856 malformations associated with ACE inhibitor use during pregnancy, a risk ratio of 2.7. The study showed no increased risk of fetal malformation associated with the use of other antihypertensives.

Antihypertensives present other dangers for pediatric patients. ACE inhibitors and angiotensin receptor blockers have the lowest diabetogenic potential in the class, said George Bakris, MD of the University of Chicago’s Pritzker School of Medicine. Beta blockers are generally acceptable, while diuretics pose the greatest danger of inducing diabetes.

But diabetogenic potential, like many other risks associated with antihypertensives, is highly dependent on patient physiology. In general, Bakris said, only patients with a body mass index over 30 or with impaired fasting glucose of 100 mg/dL or higher are at risk. Patients with a normal BMI and glucose levels should not worry about developing diabetes as a result of antihypertensive therapy.