congenital adrenal hyperplasia in children: the relationship between plasma renin activity and hypertension

Background: 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. methods: 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 t test analysis and multiple logistic regression test. statistical significance was achieved if p<0.05.results: 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. conclusion: children with salt-wasting cah with low pra levels had a higher risk of getting hypertension.