Onalo Richard, Cilliers Antoinette, Cooper Peter
Department of Paediatrics, Faculty of Clinical Sciences, University of Abuja, Nigeria and Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of The Witwatersrand Johannesburg, South Africa.
Department of Paediatrics & Child Health, University of The Witwatersrand Johannesburg, South Africa.
Am J Cardiovasc Dis. 2021 Feb 15;11(1):136-147. eCollection 2021.
Sickle cell anaemia (SCA) patients generally have lower blood pressures compared to those with the AA haemoglobin genotype. However, during vaso-occlusive crises (SCA-VOC), blood pressures (BP) may elevate transiently to levels beyond the 95 percentile. The risk of stroke or even death increases with increasing systolic BP in SCA. Therefore, interventions targeted at BP reduction may be essential during severe vaso-occlusive episodes. Reduction in BP was achieved with arginine therapy in a meta-analysis of randomized controlled trials (RCT) in non-sickle cell adults. The impact of oral arginine (given for pain control) on the BP of children with SCA-VOC has not been documented.
A double-blind RCT of oral -arginine hydrochloride as adjuvant therapy for pain reduction was conducted in children with SCA-VOC, aged 5-17 years, over a 2-year period. The mean change in BP and the time to achieve BP <90 percentile was added as part of the outcome variables. The anthropometry, pain scores and mercury sphygmomanometry were done following standard procedures. BP percentiles were generated using the guidelines. Differences in the time to normalization of BP in the treatment arms were tested with Kaplan-Meier analysis.
Sixty-six children (57.6% male) were randomized into -arginine (35 patients) or placebo (31 patients) arm. The prevalence of hypertension (BP ≥95 percentile) at presentation tended to increase as the pain scores increased, from a prevalence of 50% in patients with a score of 7 to 65% in those with score of 10 (systolic hypertension) and from 44.4% in patients with pain score of 7 to 50% in patients with pain score of 10 (diastolic hypertension). Patients that received arginine recorded a 12.8±3.2 mmHg decline in mean systolic BP compared to the placebo group, where a mean difference of 7.6±1.5 mmHg was observed, P<0.001. Similarly, the mean diastolic BP reduced by 13% in the arginine group and 7.5% in the placebo group, P<0.001. Children who received arginine tended to achieve BP normalization much faster than the placebo group (P=0.112), and no serious adverse events were documented related to the hypertension or arginine administration.
High blood pressure (≥95 percentile) is common amongst children with SCA-VOC and are mostly asymptomatic. Administration of oral arginine given for pain control achieves a reduction of the BP at a faster rate in children compared to placebo and it is safe.
与具有AA血红蛋白基因型的患者相比，镰状细胞贫血（SCA）患者的血压通常较低。然而，在血管闭塞性危机（SCA - VOC）期间，血压（BP）可能会短暂升高至超过第95百分位数的水平。在SCA中，中风甚至死亡的风险会随着收缩压的升高而增加。因此，在严重的血管闭塞发作期间，针对降低血压的干预措施可能至关重要。在一项针对非镰状细胞成年患者的随机对照试验（RCT）的荟萃分析中，精氨酸疗法可降低血压。口服精氨酸（用于控制疼痛）对患有SCA - VOC的儿童血压的影响尚未见报道。
在5至17岁患有SCA - VOC的儿童中，进行了一项为期2年的口服盐酸精氨酸作为辅助治疗以减轻疼痛的双盲RCT。作为结局变量的一部分，增加了血压的平均变化以及血压降至<第90百分位数的时间。人体测量、疼痛评分和汞柱式血压测量均按照标准程序进行。使用指南生成血压百分位数。用Kaplan - Meier分析检验治疗组中血压恢复正常时间的差异。
66名儿童（57.6%为男性）被随机分为精氨酸组（35例患者）或安慰剂组（31例患者）。就诊时高血压（BP≥第95百分位数）的患病率往往随着疼痛评分的增加而增加，疼痛评分为7分的患者患病率为50%，评分为10分的患者（收缩期高血压）患病率为65%，疼痛评分为7分的患者舒张压高血压患病率为44.4%，评分为10分的患者患病率为50%。与安慰剂组相比，接受精氨酸治疗的患者平均收缩压下降了12.8±3.2 mmHg，安慰剂组平均差异为7.6±1.5 mmHg，P<0.001。同样，精氨酸组的平均舒张压下降了13%，安慰剂组下降了7.5%，P<0.001。接受精氨酸治疗的儿童血压恢复正常的速度往往比安慰剂组快得多（P = 0.112），并且未记录到与高血压或精氨酸给药相关的严重不良事件。
高血压（≥第95百分位数）在患有SCA - VOC的儿童中很常见，且大多无症状。与安慰剂相比，用于控制疼痛的口服精氨酸给药能使儿童血压更快降低，并且是安全的。
