CASE REPORT article
Front. Pediatr.
Sec. Neonatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1504180
This article is part of the Research TopicBronchopulmonary Dysplasia: Latest Advances-Volume IIView all 10 articles
The rationale of using angiotensin receptor blocker instead of pulmonary vasodilators to treat pulmonary hypertension in bronchopulmonary dysplasia: a case report and literature review
Provisionally accepted
- Lund University, Lund, Sweden
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This case report highlights the challenges in treating bronchopulmonary dysplasia (BPD) in a premature infant with severe pulmonary hypertension, recurrent pulmonary hypertensive crises, and the need of 100% oxygen to achieve acceptable arterial oxygen saturations. Key factors in the infant´s improvement involved switching from pulmonary vasodilation to systemic afterload reduction using losartan, an angiotensin II type 1 receptor blocker. This alteration in treatment strategy led to a pronounced and prompt decrease in pulmonary arterial pressure, reduced oxygen dependency and resolution of pulmonary hypertensive crises.The infant´s remarkable clinical response suggests that the pulmonary hypertension in BPD may have a pulmonary post-capillary cause, possibly driven by angiotensin II. A literature review corroborates this revision of the current understanding of the pathophysiologic mechanism involved in BPD and suggests that therapies targeting the renin-angiotensin-aldosterone system rather than pulmonary vasodilation may be an effective treatment strategy.
Keywords: Bronchopulmonary Dysplasia, pulmonary hypertension, angiotensin receptor blocker, phosphodiesterase type 5 inhibitor, prematurity
Received: 30 Sep 2024; Accepted: 30 Apr 2025.
Copyright: © 2025 Lindberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lars Lindberg, Lund University, Lund, Sweden
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