Effect of Pomegranate Extract On N-Terminal Pro Brain Natriuretic Peptide and Asymmetric Dimetylarginine Levels in Children with Pulmonary Artery Hypertension in Acyanotic Congenital Heart Disease

Background: Pulmonary arterial hypertension (PAH) is one of the complications due to acyanotic congenital heart disease. New treatment approach using natural ingredients from plants has been demonstrated in vitro to prevent and improve vascular remodeling in PAH. Objective: This study aimed to analyze the effect of pomegranate extract on N-terminal pro brain natriuretic peptide (NT pro BNP) and asymmetric dimethylarginine (ADMA) levels in children with PAH in acyanotic CHD. Method: This study is a double-blind, quasi-experimental text with pre-test, post-test, and control group approach to children aged one month to 10 years old in Outpatient Department of Pediatric Cardiology Department/Pediatrics Department RSUD Dr. Soetomo in the period of February-October 2022, alongside met the inclusion criteria. Data were analyzed using Wilcoxon and Mann-Whitney test with 95% CI. Result: The study cohort included 15 subjects in the placebo group and 15 subjects in pomegranate extract group. The study was predominantly female (53,3%) with a mean age of each group, i.e., placebo group was 49 months, and pomegranate extract group was 58 months. The mean level of NT pro-BNP in the pomegranate extract group was 29.31 ± 33.55 ng/L (p= 0.008) and its mean ADMA level was 5619 ± 6166 ng/L (p= 0.173). As for the difference of NT pro-BNP and ADMA level changes after the intervention did not show a significant difference (p-0,330; p=0,885, respectively). Conclusion: No significant effect towards NT pro- BNP and ADMA levels found with giving pomegranate extract to children with PAH due to acyanotic CHD.