Abstract
Recently updated clinical guidelines have highlighted the gaps in our understanding and management of pediatric hypertension. With increased recognition and diagnosis of pediatric hypertension, the use of antihypertensive agents is also likely to increase. Drug selection to treat hypertension in the pediatric patient population remains challenging. This is primarily due to a lack of large, well-designed pediatric safety and efficacy trials, limited understanding of pharmacokinetics in children, and unknown risk of prolonged exposure to antihypertensive therapies. With newer legislation providing financial incentives for conducting clinical trials in children, along with publication of pediatric-focused guidelines, literature available for antihypertensive agents in pediatrics has increased over the last 20 years. The objective of this article is to review the literature for safety and efficacy of commonly prescribed antihypertensive agents in pediatrics. Thus far, the most data to support use in children was found for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB). Several gaps were noted in the literature, particularly for beta blockers, vasodilators, and the long-term safety profile of antihypertensive agents in children. Further clinical trials are needed to guide safe and effective prescribing in the pediatric population.
Highlights
Hypertension (HTN) in children and adolescents is defined as an average clinic measured systolic blood pressure (SBP) and/ or diastolic blood pressure (DBP) ≥ 95th percentile [1]
In children and adolescents diagnosed with HTN, the treatment goal with non-pharmacologic and pharmacologic therapy should be a reduction in SBP and DBP to < 90th percentile or < 130/80 mm Hg, whichever is lower [1]
We aim to review the most common drug classes and pharmacologic agents used to manage HTN in pediatrics (0 to 18 years old) with an emphasis on safety (Table 1)
Summary
Hypertension (HTN) in children and adolescents is defined as an average clinic measured systolic blood pressure (SBP) and/ or diastolic blood pressure (DBP) ≥ 95th percentile (on the basis of age, sex, and height percentiles) [1]. It should be noted that despite theoretical implications of using aliskerin in combination with ACE-I and ARBs to treat “renin and aldosterone escape” in patients with proteinuria [61, 62], studies have reported a significant increase in the adverse effect profile, namely hyperkalemia, hypotension, and renal failure especially in patients with preexisting CKD [62–64]. The authors noted a statistically significant reduction in mean sitting SBP (p < 0.05) and DBP (p < 0.05), there was no statistical difference in the percentage of patients achieving target BP control (45% treatment group versus 34% placebo, p = NS) [119] Based on these results, this drug combination did not attain FDA approval for use in pediatrics. A single-dose study of minoxidil in pediatric patients aged 2 to 18 years on a beta blocker and diuretic showed statistically significant post-dose reduction in SBP and DBP (p < 0.05) [137]. Epidemiological and longitudinal cohort studies of adults exposed to antihypertensive medications in their childhood are needed. & Recent studies looking at the role of the immune system in the development of HTN, and others aiming at manipulating the gut microbiota to lower BP (NCT02037295) may bring new approaches and medication classes that have a “broader” safety profile [141]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call