1
|
Thompson EJ, Wood CT, Hornik CP. Pediatric Pharmacology for the Primary Care Provider: Advances and Limitations. Pediatrics 2024; 154:e2023064158. [PMID: 38841764 PMCID: PMC11211696 DOI: 10.1542/peds.2023-064158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/07/2024] [Accepted: 04/02/2024] [Indexed: 06/07/2024] Open
Abstract
Despite >1 in 5 children taking prescription drugs in the United States, off-label drug use is common. To increase the study of drugs in children, regulatory bodies have enacted legislation to incentivize and require pediatric drug studies. As a result of this legislation, novel trial approaches, and an increase in personnel with pediatric expertise, there have been numerous advancements in pediatric drug development. With this review, we aim to highlight developments in pediatric pharmacology over the past 6 years for the most common disease processes that may be treated pharmacologically by the pediatric primary care provider. Using information extracted from label changes between 2018 and 2023, the published literature, and Clinicaltrials.gov, we discuss advances across multiple therapeutic areas relevant to the pediatric primary care provider, including asthma, obesity and related disorders, mental health disorders, infections, and dermatologic conditions. We highlight instances in which new drugs have been developed on the basis of a deeper mechanistic understanding of illness and instances in which labels have been expanded in older drugs on the basis of newly available data. We then consider additional factors that affect pediatric drug use, including cost and nonpharmacologic therapies. Although there is work to be done, efforts focused on pediatric-specific drug development will increase the availability of evidence-based, labeled guidance for commonly prescribed drugs and improve outcomes through the safe and effective use of drugs in children.
Collapse
Affiliation(s)
- Elizabeth J. Thompson
- Duke University Hospital, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Christoph P. Hornik
- Duke University Hospital, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|
2
|
Ledeganck KJ, Van Eyck A, Wouters K, Vermeiren E, De Winter BY, Verhulst S, Van Hoorenbeeck K, France A, Dotremont H, den Brinker M, Trouet D. Urinary epidermal growth factor reflects vascular health in boys with either obesity or type 1 diabetes. A role for renin, or beyond? PLoS One 2023; 18:e0283716. [PMID: 36996194 PMCID: PMC10062545 DOI: 10.1371/journal.pone.0283716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
An increased blood pressure is a known comorbidity of both type 1 diabetes (T1DM) and obesity in children. Increasing evidence suggests a subtle interplay between epidermal growth factor (EGF) and renin along the juxtaglomerular system, regulating the impact of blood pressure on kidney health and the cardiovascular system. In this study, we investigated the relation between urinary EGF, serum renin and blood pressure in children with obesity or T1DM. 147 non-obese children with T1DM and 126 children with obesity, were included. Blood pressure was measured and mean arterial pressure (MAP) and the pulse pressure (PP) were calculated. Serum renin and urinary EGF levels were determined with a commercial ELISA kit. Partial Spearman rank correlation coefficients and multiple linear regression models were used to study the association between renin, the urinary EGF/urinary creatinine ratio and blood pressure parameters. The urinary EGF/urinary creatinine ratio is correlated with the SBP and the MAP in boys with obesity as well as in boys with T1DM. Multiple regression analysis showed that sex and pulse pressure in male subjects were found to be independently associated with renin. Sex, the presence of diabetes, age, the glomerular filtration rate and both pulse pressure and mean arterial pressure in male subjects were independently associated with urinary EGF/urinary creatinine. In conclusion, in boys with either obesity or diabetes, pulse pressure and mean arterial pressure are negatively associated with the functional integrity of the nephron, which is reflected by a decreased expression of urinary EGF.
Collapse
Affiliation(s)
- Kristien J Ledeganck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Clinical Research Center Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Eline Vermeiren
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Annick France
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Hilde Dotremont
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Marieke den Brinker
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Dominique Trouet
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Paediatric Nephrology, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
3
|
Race, obesity, and the renin-angiotensin-aldosterone system: treatment response in children with primary hypertension. Pediatr Nephrol 2017; 32:1585-1594. [PMID: 28411317 DOI: 10.1007/s00467-017-3665-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pediatric primary hypertension (HTN) is increasingly recognized, but the effect of patient characteristics such as obesity and race on treatment outcomes is not well described. The renin-angiotensin-aldosterone system (RAAS) may also contribute to HTN. We hypothesized patient parameters of these factors, including baseline RAAS, influence blood pressure (BP) response to pharmacological treatment in HTN. METHODS This was a retrospective cohort of 102 consecutive patients with HTN. Primary outcomes were changes per year in systolic and diastolic BP (SBP, DBP). Secondary outcome was change per year in left ventricular mass index (LVMI). We evaluated whether baseline plasma renin activity (PRA), aldosterone, renin-to-aldosterone ratio, overweight/obesity, race, initial drug choice, and multidrug therapy were associated with the outcomes using general linear regression models adjusted for confounding variables. RESULTS Racially diverse (43% Hispanic, 28% black, 25% white) and predominantly overweight/obese (75%) patients were studied. Median length of follow-up was 14.5 months. Higher baseline aldosterone was associated with decreased SBP (-1.03 mmHg/year), DBP (-0.95 mmHg/year), and DBP z score (-0.07/year) during the study period. Higher baseline PRA was associated with decreased SBP z score (-0.04/year) and LVMI (-2.89 g/m2.7/year). Stratified analyses revealed the relationships between baseline aldosterone and PRA, and annual reductions in outcomes were strengthened in nonobese and white patients. CONCLUSIONS Pretreatment aldosterone and PRA predicted short-term follow-up BP and LVMI, especially in nonobese and white patients. The RAAS profile could guide treatment of HTN and suggests consideration of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers as first-line treatment options.
Collapse
|
4
|
Atenolol vs enalapril in young hypertensive patients after successful repair of aortic coarctation. J Hum Hypertens 2015; 30:363-7. [DOI: 10.1038/jhh.2015.87] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/26/2015] [Accepted: 07/10/2015] [Indexed: 12/30/2022]
|
5
|
Abstract
Hypertension has been recognized as an important health issue in the pediatric population over the past years. This emphasizes the need for an organized and effective plan for diagnosis and management. This review provides information to guide physicians through a structured approach to (1) screen children for hypertension during routine visits; (2) use normative blood pressure tables for diagnosis and classification; (3) perform a clinical evaluation to identify the presence of risk factors, comorbidities and/or target organ damage; and (4) initiate an individualized plan of care that includes follow-up blood pressure measurement, therapeutic lifestyle changes and - if necessary - pharmacological therapies.
Collapse
|
6
|
Abstract
Hypertension in children and adolescents, once thought to be rare, has been estimated at a current prevalence of between 1% and 5% in the United States. The prevalence of primary hypertension continues to increase with the increasing body mass index of the pediatric population. Who is at risk? If and when to screen? When and how to treat? These controversial questions are important to the physician in primary care practice.
Collapse
Affiliation(s)
- Debra Ahern
- Department of Community and Family Medicine, TMC Lakewood, 7900 Lee's Summit Road, Kansas City, MO 64139, USA.
| | - Emily Dixon
- Bethesda Family Practice and Sports Medicine Fellowship, Trihealth Orthopedic and Spine Institute, 8311 Montgomery Rd, Cincinnati, OH 45236, USA
| |
Collapse
|
7
|
Schmitt C, Kervégant M, Ajaltouni Z, Tauber M, Tichadou L, de Haro L. [Clonidine poisoning in a child: a case report]. Arch Pediatr 2014; 21:1213-5. [PMID: 25284732 DOI: 10.1016/j.arcped.2014.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 04/04/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
Clonidine poisoning's clinical feature is well documented in the medical literature, but the minimal toxic dose has not yet been established. The effectiveness of naloxone is also controversial. The authors describe a clonidine overdose in a 9-year-old boy (25 kg) during a growth hormone test: he received tenfold the prescribed clonidine dose (0.23 mg instead of 0.023 mg) with 6.2 mg betaxolol. About 40 min later, he became drowsy and then complained of low blood pressure, bradycardia, and myosis. By maintaining the Trendelenburg position, administering fluids as well as salbutamol and naloxone (three doses of 0.2 mg were required), he recovered and was discharged from the hospital on day 2. The minimal clonidine toxic dose, the clinical picture, and the effectiveness of naloxone administration are discussed in this paper.
Collapse
Affiliation(s)
- C Schmitt
- Centre antipoison de Marseille, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - M Kervégant
- Centre antipoison de Marseille, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Z Ajaltouni
- Service de pédiatrie, centre hospitalier de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - M Tauber
- Service de pédiatrie, centre hospitalier de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - L Tichadou
- Centre antipoison de Marseille, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - L de Haro
- Centre antipoison de Marseille, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| |
Collapse
|
8
|
|
9
|
Rached-d'Astous S, Dahdah N, Brochu P, Saint-Cyr C. Rapidly progressive aortic aneurysmal dilation in a child with systemic lupus erythematosus: too early too severe. BMJ Case Rep 2014; 2014:bcr-2013-201014. [PMID: 24891474 DOI: 10.1136/bcr-2013-201014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
About 10-20% of systemic lupus erythematosus cases occur in children, often with more severe features at onset and more active disease over time compared with adults. Cardiovascular complications are common in this population but thoracic aortic aneurysms rarely occur. Although the pathophysiology of this complication remains unclear, vasculitis seems to play an important role, leading to degeneration and fibrosis of the media and formation of the aneurysm. We report the case of a 9-year-old systemic lupus erythematosus patient with important renal involvement, who underwent aortic replacement surgery for the treatment of an aortic aneurysm. This case highlights the importance of monitoring the thoracic aorta in children with systemic lupus erythematosus and the need for the development of appropriate early management strategies for this serious complication.
Collapse
Affiliation(s)
- Soha Rached-d'Astous
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Sainte-Justine, University of Montreal, Canada
| | - Pierre Brochu
- Department of Pathology, CHU Sainte-Justine, University of Montreal, Canada
| | - Claire Saint-Cyr
- Division of Pediatric Rheumatology, CHU Sainte-Justine, University of Montreal, Canada
| |
Collapse
|
10
|
Rational use of antihypertensive medications in children. Pediatr Nephrol 2014; 29:979-88. [PMID: 23715784 DOI: 10.1007/s00467-013-2510-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/09/2013] [Accepted: 05/07/2013] [Indexed: 12/13/2022]
Abstract
Hypertension has traditionally been regarded as an uncommon diagnosis in childhood and adolescence; however, there is compelling evidence to suggest that its prevalence is on the rise, particularly in those with obesity. As a result, pediatricians increasingly are asked to evaluate and manage patients with elevated blood pressure. An increased emphasis on conducting drug trials in children over the last 15 years has yielded important advances with respect to evidence-based data regarding the efficacy and safety of antihypertensive medications in children and adolescents. Unfortunately, data to definitively guide selection of initial agents is lacking. This article will present guidelines for the appropriate use of antihypertensive medications in the pediatric population, including the rational approach to selecting an appropriate medication with respect to pathophysiology, putative benefit, and likelihood for side effects.
Collapse
|
11
|
Bassareo PP, Mercuro G. Pediatric hypertension: An update on a burning problem. World J Cardiol 2014; 6:253-259. [PMID: 24944755 PMCID: PMC4062118 DOI: 10.4330/wjc.v6.i5.253] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/25/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
A large number of adults worldwide suffer from essential hypertension, and because blood pressures (BPs) tend to remain within the same percentiles throughout life, it has been postulated that hypertensive pressures can be tracked from childhood to adulthood. Thus, children with higher BPs are more likely to become hypertensive adults. These “pre-hypertensive” subjects can be identified by measuring arterial BP at a young age, and compared with age, gender and height-specific references. The majority of studies report that 1 to 5% of children and adolescents are hypertensive, defined as a BP > 95th percentile, with higher prevalence rates reported for some isolated geographic areas. However, the actual prevalence of hypertension in children and adolescents remains to be fully elucidated. In addition to these young “pre-hypertensive” subjects, there are also children and adolescents with a normal-high BP (90th-95th percentile). Early intervention may help prevent the development of essential hypertension as they age. An initial attempt should be made to lower their BP by non-pharmacologic measures, such as weight reduction, aerobic physical exercise, and lowered sodium intake. A pharmacological treatment is usually needed should these measures fail to lower BP. The majority of antihypertensive drugs are not formulated for pediatric patients, and have thus not been investigated in great detail. The purpose of this review is to provide an update concerning juvenile hypertension, and highlight recent developments in epidemiology, diagnostic methods, and relevant therapies.
Collapse
|
12
|
Lande MB, Adams HR, Kupferman JC, Hooper SR, Szilagyi PG, Batisky DL. A multicenter study of neurocognition in children with hypertension: methods, challenges, and solutions. ACTA ACUST UNITED AC 2013; 7:353-62. [PMID: 23792121 DOI: 10.1016/j.jash.2013.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/24/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022]
Abstract
Hypertensive adults demonstrate decreased performance on neurocognitive testing compared with that of normotensive controls. There is now emerging, preliminary evidence that children with hypertension also manifest neurocognitive differences when compared with normotensive controls, findings postulated to potentially represent early signs of hypertensive target organ damage to the brain. However, reports in children to date have been limited to database and single-center studies. We have established an ongoing, prospective, multicenter study of neurocognition in children with primary hypertension. This article outlines the study methods, with particular attention to the unique challenges in this area of clinical research. We highlight aspects of the study design that are specifically designed as solutions to these challenges.
Collapse
Affiliation(s)
- Marc B Lande
- Department of Pediatrics, University of Rochester, Rochester, NY.
| | | | | | | | | | | |
Collapse
|
13
|
Pabari RM, McDermott C, Barlow J, Ramtoola Z. Stability of an alternative extemporaneous captopril fast-dispersing tablet formulation versus an extemporaneous oral liquid formulation. Clin Ther 2013; 34:2221-9. [PMID: 23149007 DOI: 10.1016/j.clinthera.2012.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Administration of medications to pediatric patients is challenging because many drugs are not commercially available in appropriate dosage formulations and/or strengths. Consequently, these drugs are prepared extemporaneously as oral liquid (OL) formulations using marketed tablets or capsules. In many cases, the stability of these extemporaneous preparations, which may affect their tolerability, has not been documented. An alternative extemporaneous solid formulation, such as a fast-dispersing tablet (FDT), may offer enhanced stability as well as dosing flexibility because it may be administered as an orodispersible tablet or as a reconstituted suspension/solution. Although FDTs are available increasingly as patient-friendly oral dosage formulations, and their simple method of manufacture can be applied to extemporaneous formulations, such applications have not been explored to date. OBJECTIVES The use of extemporaneous captopril OL formulations in hospitals in Ireland was surveyed, and the stability of the most commonly used captopril formulation (reference) was investigated and compared with that of a newly available extemporaneous FDT formulation. METHODS The survey was carried out in 120 hospitals in the Republic of Ireland. The 56-day stability of the most commonly used formulation was compared with that of a newly available extemporaneous captopril FDT preparation. The captopril content of the formulations was measured by high-performance liquid chromatography analysis. Formulations were also monitored for changes in appearance, including color; odor; and pH (OLs only). RESULTS The survey showed that extemporaneously prepared captopril OLs were extensively used, particularly in specialist children's hospitals. The most commonly used preparation was a xanthan gum-based oral suspension. Analysis of these OL preparations showed the OLs to have been stable up to day 7, but that the captopril concentration decreased to 72% to 84% at day 14 and to 59% to 68% at day 56; this decrease was accompanied by a pungent odor suggestive of captopril oxidation. In contrast, FDT formulations demonstrated greater stability, with 96% of captopril present at day 56. CONCLUSIONS The results of this study support only a 7-day stability for the currently dispensed captopril OL in hospitals in Ireland. In contrast, a stability of at least 56 days was shown with the FDTs. The FDTs may represent an alternative and convenient oral solid extemporaneous preparation of captopril and, potentially, other extemporaneous pediatric medications.
Collapse
Affiliation(s)
- Ritesh M Pabari
- School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Republic of Ireland
| | | | | | | |
Collapse
|
14
|
Muir VJ, Keating GM. Olmesartan medoxomil in children and adolescents with hypertension†: profile report. Paediatr Drugs 2012; 14:209-10. [PMID: 22497554 DOI: 10.2165/11207290-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
†Adapted and reproduced from the original article published in Drugs 2010; 70 (18): 2439-47.
Collapse
|
15
|
Welch WP, Yang W, Taylor-Zapata P, Flynn JT. Antihypertensive drug use by children: are the drugs labeled and indicated? J Clin Hypertens (Greenwich) 2012; 14:388-95. [PMID: 22672093 DOI: 10.1111/j.1751-7176.2012.00656.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As a result of the Food and Drug Administration (FDA) Modernization Act and the Best Pharmaceuticals for Children Act, the number of medications with FDA-approved pediatric labeling has increased. To assess the success of these initiatives, we examined whether antihypertensive drugs used by children with hypertension in 2008 had FDA-approved pediatric labeling and indications. Using a nationwide commercial insurer database, 2915 children with primary (n=2607) and secondary (n=308) hypertension were identified. Drug user rate and days of supply were calculated from pharmacy claims. Drugs were categorized based on pediatric labeling and indication and whether they were recommended for pediatric use. Antihypertensive drugs were used by 889 (34%) children with primary hypertension and 200 children (65%) with secondary hypertension. User rates were 44.3% in hypertensive children younger than 6 years, 30.9% in those 6 years to older than 12 years, and 38.1% in those 12 years to older than 18 years. Seven percent of drugs were neither labeled for pediatric use nor considered recommended for use in children. In children younger than 6 years, 29% of drugs used were not indicated for use in that age group. Despite recent legislative initiatives, many drugs used by hypertensive children still lack pediatric labeling. Additional efforts are needed to close the gap between the availability of drugs that are labeled and indicated for pediatric use and actual drug usage in children.
Collapse
|
16
|
Stephens MM, Fox BA, Maxwell L. Therapeutic options for the treatment of hypertension in children and adolescents. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2012; 6:13-25. [PMID: 22408373 PMCID: PMC3296488 DOI: 10.4137/ccrpm.s7602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%-5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies.
Collapse
Affiliation(s)
- Mary M Stephens
- Department of Family and Community Medicine Christiana Care Health System
| | | | | |
Collapse
|
17
|
Meyers RS, Siu A. Pharmacotherapy Review of Chronic Pediatric Hypertension. Clin Ther 2011; 33:1331-56. [DOI: 10.1016/j.clinthera.2011.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/31/2011] [Accepted: 09/05/2011] [Indexed: 12/16/2022]
|
18
|
Hari P, Sinha A. Hypertensive emergencies in children. Indian J Pediatr 2011; 78:569-75. [PMID: 21271305 DOI: 10.1007/s12098-010-0297-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 11/12/2010] [Indexed: 11/30/2022]
Abstract
Hypertensive emergencies, though uncommon in children, are potentially life threatening. While targeting blood pressure reduction to below the 90th percentile for age, gender and height, mean arterial blood pressure should be gradually lowered by one-fourth of the planned reduction over 8-12 h, a further fourth over the next 8-12 h, and the final 50% over the 24 h after that. Frequent invasive or non-invasive blood pressure monitoring is essential, as is monitoring for sensorial alteration and loss of papillary reflexes. Few antihypertensive agents have been examined in children. Continuous intravenous infusions of short acting drugs such as nitroprusside, labetalol and nicardipine are preferred to intravenous boluses of hydralazine or diazoxide. If severe symptoms are absent, oral agents such as nifedipine, clonidine, minoxidil, hydralazine, labetalol, captopril, and prazosin may be used. Nicardipine and labetalol are particularly suited in emergencies with intracranial bleeding or ischemic stroke, while furosemide, sodium nitroprusside and nitroglycerine are useful in congestive cardiac failure. Therapy with oral antihypertensive drugs should be instituted within 6-12 h of parenteral therapy, and the latter gradually withdrawn over the next 12-48 h. Oral agents have limited application as primary therapy, except when administration of intravenous infusion is likely to be delayed. This article provides a summary of the clinical approach to evaluation and management of severe symptomatic hypertension in children.
Collapse
Affiliation(s)
- Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
| | | |
Collapse
|
19
|
Wells T, Blumer J, Meyers KEC, Neto JPR, Meneses R, Litwin M, Vande Walle J, Solar-Yohay S, Shi V, Han G. Effectiveness and safety of valsartan in children aged 6 to 16 years with hypertension. J Clin Hypertens (Greenwich) 2011; 13:357-65. [PMID: 21545397 DOI: 10.1111/j.1751-7176.2011.00432.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The effectiveness and safety of valsartan have not been assessed in hypertensive children. Therefore, hypertensive patients aged 6 to 16 years (n=261) were randomized to receive weight-stratified low- (10/20 mg), medium- (40/80 mg), or high-dose (80/160 mg) valsartan for 2 weeks. After 2 weeks, patients were randomized to a 2-week placebo-controlled withdrawal phase. Dose-dependent reductions in sitting systolic blood pressure (SSBP) and sitting diastolic blood pressure (SDBP) were observed after 2 weeks (low dose, -7.9/-4.6 mm Hg; medium dose, -9.6/-5.8 mm Hg; high dose, -11.5/-7.4 mm Hg [P<.0001 for all groups]). During the withdrawal phase, SSBP and SDBP were both lower in the pooled valsartan group than in the pooled placebo group (SSBP, -2.7 mm Hg [P=.0368]; SDBP, -3.0 mm Hg [P=.0047]). Similar efficacy was observed in all subgroups. Valsartan was well tolerated and headache was the most commonly observed adverse event during both the double-blind and 52-week open-label phases.
Collapse
Affiliation(s)
- Thomas Wells
- University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Brambilla P, Pozzobon G, Pietrobelli A. Physical activity as the main therapeutic tool for metabolic syndrome in childhood. Int J Obes (Lond) 2010; 35:16-28. [PMID: 21139560 DOI: 10.1038/ijo.2010.255] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Physical activity (PA) and diet directly influence obesity and metabolic syndrome (MS) as important determinants of body composition. Understanding how PA relates to MS in youth is of great importance, and could offer a common strategy for clinical and public health approaches to control this condition. The underlying disorder of MS is a condition of insulin resistance, and a strong relationship between PA level and insulin sensitivity is clearly ascertained. The type, duration, frequency and intensity of PA affect fuel metabolism, in particular carbohydrate and lipid oxidation. The possible modulation of metabolism because of increased fat oxidation by PA is the basis for both prevention and restoration of insulin resistance and MS in obese children. In daily clinical practice, diet followed by pharmacologic treatment are usually the approaches taken, whereas PA is often considered just a suggestion. Although diet and PA have different effects on body composition, with both contributing to fat loss, only PA increases muscle mass and thus has a direct effect on metabolic function, expressed by changes in cardiovascular risk factors. Therefore, it is important to remember their complementary but different targets in daily clinical practice, such as body weight control for diet and metabolic health for PA. In this review, we have summarized the literature on the relationship between PA and MS in pediatrics. Then, we have analyzed the possibility of using PA for MS treatment, as an alternative to drugs, by discussing the results of intervention studies, reasons for low compliance to PA, related benefits, adherence difficulties and costs. Finally, we have tried to suggest recommendations for a multiple-step PA strategy in children and adolescents at risk for MS, by considering PA as the 'key' player in treatment.
Collapse
|
21
|
|
22
|
|
23
|
Abstract
In adults, hypertension has long been perceived as a public health problem. By contrast, its impact in childhood is far less appreciated. In fact, quite often, high blood pressure in children is not even diagnosed. Blood pressure is a vital sign that is routinely obtained during a physical examination of adults, but only very seldom in children. The diagnosis of hypertension in children is complicated because 'normal' blood pressure values vary with age, sex and height. As a consequence, almost 75% of the cases of arterial hypertension and 90% of the cases of prehypertension in children and adolescents are currently undiagnosed. Furthermore, adolescence hypertension is increasing in prevalence as the prevalence of pediatric obesity has increased. Ambulatory blood pressure monitoring is a useful method for risk evaluation in adolescents. In addition to being viewed as an important cardiovascular risk factor in adolescents, elevated blood pressure should prompt a thorough search for other modifiable risk factors that, if treated, might reduce teenagers' risk of developing cardiovascular disease in adulthood. Thus, assessing blood pressure values in children represents one of the most important measurable markers of cardiovascular risk later in life and a major step in preventive medicine.
Collapse
Affiliation(s)
- Marlene Aglony
- Pediatric Nephrologist, Instructor in Pediatrics, Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | |
Collapse
|
24
|
Yim HE, Lee EH, Jang GY, Yoo KH, Son CS, Hong YS, Lee JW, Ito Y, Ikezumi Y, Uchiyama M. Questionnaire survey on pediatric hypertension in Japan and Korea. Pediatr Int 2010; 52:1-5. [PMID: 19419516 DOI: 10.1111/j.1442-200x.2009.02860.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hypertension (HTN) is no longer viewed as an adult disease. The purpose of the present study was to understand how hypertensive children are evaluated and managed, by surveying pediatricians in Japan and South Korea. METHODS A questionnaire was mailed to 109 Japanese (JA) and 159 Korean (KO) pediatric cardiologists, pediatric nephrologists, and other pediatricians. RESULTS A total of 127 replies were received (response rate 47%). Most of respondents did not check blood pressure (BP) routinely in outpatient clinics (JA 77%, KO 88%). A mercury sphygmomanometer was the most commonly used method for BP measurements (JA 72%, KO 62%). BP treatment goals were usually set at the 95th percentile for age, gender, and height (JA 47%, KO 54%). More KO used a lower goal in children with primary HTN than JA. KO respondents preferred angiotensin-converting enzyme inhibitors (ACEI) as initial agents regardless of underlying diseases whereas JA respondents chose various medications, that is, calcium channel blockers, diuretics, and ACEI. For BP monitoring, self-monitoring was found to be most frequent in both countries (JA 80%, KO 57%). Ambulatory BP monitoring was not frequently utilized in both countries (JA 33% KO 34%). CONCLUSION The current assessment, management and differing trends in pediatric HTN in Japan and Korea have been identified in the present study. Pediatricians should be aware of the growing implications of HTN in children.
Collapse
Affiliation(s)
- Hyung Eun Yim
- Department of Pediatrics, Korea University, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
The epidemic of overweight and obesity in youth is increasing the prevalence of prehypertension and hypertension among children and adolescents. The younger the child is at presentation and the more severe the blood pressure abnormality, the more likely a secondary cause of hypertension is to be present. Measurement of blood pressure in children requires adaptation to the age and size of the child. Interpretation must be related to normative values specific for age, sex, and height. Evaluation is primarily aimed at identifying secondary causes of hypertension, associated comorbidities, additional risk factors, and evidence of target-organ damage. Ambulatory blood pressure monitoring is emerging as a useful tool for evaluation of some patients, particularly for those with suspected 'white coat' hypertension. Management of prehypertension and hypertension is directed at the underlying cause, exacerbating factors, and the magnitude of the blood pressure abnormality. Healthy behavioral changes are a primary management tool for treating hypertension and, more particularly, prehypertension and for addressing other cardiovascular risk factors, such as obesity. Pharmacological management is reserved for patients with hypertension who do not respond to behavioral changes, have additional cardiovascular risk factors or diabetes, are symptomatic, or have developed target-organ damage.
Collapse
Affiliation(s)
- Brian W McCrindle
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| |
Collapse
|
26
|
Affiliation(s)
- Ian M Paul
- Department of Pediatrics and Public Health Sciences, The Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, HS83, Hershey, PA 17033, USA.
| |
Collapse
|
27
|
DiPietro A, Kees-Folts D, DesHarnais S, Camacho F, Wassner SJ. Primary hypertension at a single center: treatment, time to control, and extended follow-up. Pediatr Nephrol 2009; 24:2421-8. [PMID: 19714367 DOI: 10.1007/s00467-009-1297-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 07/26/2009] [Accepted: 07/28/2009] [Indexed: 01/20/2023]
Abstract
We present data on presentation, treatment, and follow-up of 65 pediatric patients with primary hypertension treated over the past 12 years, including initial anthropometric data, pharmacologic treatment, time to control for both systolic and diastolic blood pressure (SBP/DBP), and maintenance of control over time. Data was normalized to standard deviation scores (SDS) for mathematical analysis, and antihypertensive medication dosages were converted to dosage equivalents for a single member of each antihypertensive class. We used multiple regression analysis and Kaplan- Meier survival curves to determine the time to control, medication, and dose effectiveness. Patients were seen for an average of seven visits over 25 months. Initial BPs averaged 134/71 mmHg (2.1/0.6 SDS). Patients were taller, heavier, and had higher body mass index than average for age and sex. By the fourth visit, SBP was <90th percentile in 79%. Ninety percent could be controlled, although 32 lost control at some point (at least 16 due to noncompliance). At the last visit, 46 were controlled, and 5/8 patients off medication remained normotensive. Only angiotensin-converting enzyme inhibitors and beta-blockers demonstrated significant association with BP control. This is the first study to document the time to control of BP, and it can serve as an initial standard for quality assessment.
Collapse
Affiliation(s)
- Amy DiPietro
- Department of Pediatrics, The Penn State College of Medicine, The Milton S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, USA
| | | | | | | | | |
Collapse
|
28
|
Short KR, Blackett PR, Gardner AW, Copeland KC. Vascular health in children and adolescents: effects of obesity and diabetes. Vasc Health Risk Manag 2009; 5:973-90. [PMID: 19997578 PMCID: PMC2788602 DOI: 10.2147/vhrm.s7116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Indexed: 12/14/2022] Open
Abstract
The foundations for cardiovascular disease in adults are laid in childhood and accelerated by the presence of comorbid conditions, such as obesity, diabetes, hypertension, and dyslipidemia. Early detection of vascular dysfunction is an important clinical objective to identify those at risk for subsequent cardiovascular morbidity and events, and to initiate behavioral and medical interventions to reduce risk. Typically, cardiovascular screening is recommended for young adults, especially in people with a family history of cardiovascular conditions. Children and adolescents were once considered to be at low risk, but with the growing health concerns related to sedentary lifestyle, poor diet and obesity, cardiovascular screening may be needed earlier so that interventions to improve cardiovascular health can be initiated. This review describes comorbid conditions that increase cardiovascular risk in youth, namely obesity and diabetes, and describes noninvasive methods to objectively detect vascular disease and quantify vascular function and structure through measurements of endothelial function, arterial compliance, and intima-media thickness. Additionally, current strategies directed toward prevention of vascular disease in these populations, including exercise, dietary interventions and pharmacological therapy are described.
Collapse
Affiliation(s)
- Kevin R Short
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | | |
Collapse
|
29
|
Habtemariam B, Sallas W, Sunkara G, Kern S, Jarugula V, Pillai G. Population pharmacokinetics of valsartan in pediatrics. Drug Metab Pharmacokinet 2009; 24:145-52. [PMID: 19430170 DOI: 10.2133/dmpk.24.145] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this work was to develop a population pharmacokinetic model to assess the influence of subject covariates on the pharmacokinetics of valsartan in children. Data were collected from a single dose study in 26 hypertensive children ages 1 to 16 years. Subjects received 2 mg/kg valsartan suspension up to a maximum dose of 80 mg. Plasma samples were collected and analyzed using LC/MS/MS. Several structural pharmacokinetic models were evaluated for appropriateness. Allometric scaling and standard covariate analyses were performed to explain interindividual variabilities. Objective function values and goodness of fit plots were used for model selection. A posterior predictive check was used for model evaluation. A linear 2-compartment first-order elimination model with zero-order absorption and lag-time best described the disposition of valsartan. Allometric scaling and standard covariate analysis revealed that age and body size have similar influence; however, after adjustment for body size using fat free mass (FFM), the effect of increasing age was no longer significant on valsartan clearance (2% per year relative to a typical 8 year old with FFM of 30 kg). The population pharmacokinetic model reveals that increase in age has minimal influence on body size dependent clearance of valsartan in children.
Collapse
|
30
|
Lande MB, Flynn JT. Treatment of hypertension in children and adolescents. Pediatr Nephrol 2009; 24:1939-49. [PMID: 17690916 PMCID: PMC2756388 DOI: 10.1007/s00467-007-0573-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 06/29/2007] [Accepted: 07/05/2007] [Indexed: 01/10/2023]
Abstract
The treatment of hypertension in children and adolescents has been markedly changed in recent years by several factors, including the publication of new consensus recommendations, the obesity epidemic, and the increased availability of information on efficacy and safety of antihypertensive medications in the young. In this review we present an updated approach to the outpatient management of hypertension in the child or adolescent, utilizing representative cases to illustrate important principles as well as possible controversies.
Collapse
Affiliation(s)
- Marc B. Lande
- Pediatric Nephrology, University of Rochester, Rochester, NY USA
| | - Joseph T. Flynn
- Division of Nephrology, A-7931, Children’s Hospital & Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| |
Collapse
|
31
|
Hypertension in children and adolescents: An approach to management of complex hyper tension in pediatric patients. Curr Hypertens Rep 2009; 11:315-22. [DOI: 10.1007/s11906-009-0054-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
32
|
Abstract
Increasing attention has been focused on identifying children with prehypertension and hypertension (HTN). Obesity and low birthweight are two risk factors that predispose children to develop HTN during their childhood years or later as adults. Early onset of pre-HTN and HTN increases the lifetime risk for cardiovascular sequelae. Lifestyle modification should be part of the initial recommendations for management of all hypertensive children. In those children requiring pharmacologic therapy, the choice of medication should be guided by the etiology of HTN, the needs of the child and the risk and benefit profiles of the various drug classes. The long-term impact of antihypertensive therapy in children is not known. Concerns regarding the effects of HTN and its treatment on cognitive function are of particular importance in the growing child and warrant further study. Ongoing investigations that offer promise for innovative therapeutic approaches in the future are discussed.
Collapse
Affiliation(s)
- Coral D Hanevold
- University of Washington, Department of Pediatrics, Division of Nephrology, Seattle Childrens Hospital, 4800 Sand Point Way NE, Mailstop A-7931, Seattle, WA 98105, USA.
| |
Collapse
|
33
|
Marcovecchio ML, Tossavainen PH, Dunger DB. Status and rationale of renoprotection studies in adolescents with type 1 diabetes. Pediatr Diabetes 2009; 10:347-55. [PMID: 19496962 DOI: 10.1111/j.1399-5448.2009.00510.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
34
|
Eymery V, Niel O, Mousnier A, Bérard E. [Key drugs and doses in the hypertension's treatment in child in France]. Arch Pediatr 2009; 16:1419-23. [PMID: 19625172 DOI: 10.1016/j.arcped.2009.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 06/02/2009] [Accepted: 06/11/2009] [Indexed: 10/20/2022]
Abstract
The prescription drug for hypertension in children remains difficult because of the lack of pharmacological data validated for this age of life. The Food and Drug Administration (FDA) has recently proposed some antihypertensive regimens orally. The authors found it useful to reproduce a table by adding all the necessary data for its use in France. Here is a list of French medicines and doses applied to children. Similarly, they made a second table for injectable antihypertensive treatment based on American recommendations--but not yet validated by FDA.
Collapse
Affiliation(s)
- V Eymery
- Pôle pharmacie, hôpital de l'Archet, CHU de Nice, 15 route de Saint-Antoine-de-Ginestière, Nice cedex 3, France.
| | | | | | | |
Collapse
|
35
|
Abstract
It has been estimated that up to 27% of all medical emergencies presenting to emergency departments are due to hypertension, predominantly in the adult population. Although this often is an insidious process, acutely, a hypertensive emergency occurs when a patient presents with severe hypertension and evidence of end organ damage. We discuss the case of a 12-year-old female with spastic cerebral palsy and global developmental delay secondary to neonatal asphyxia who presented to the emergency department after having a seizure at home. On arrival to the emergency department, she was found to have a heart rate (HR) of 170 and a left upper extremity blood pressure of 174/112. Initial electrocardiogram revealed a HR of 163, with significant ST segment elevations in leads I, II, and minimal elevations in V4, 5, and 6. Intravenous Metoprolol 2.5 mg was administered 3 times with 5 minutes interval between doses, which resulted in a decline in HR (106) and blood pressure (128/86), and subsequent resolution of the electrocardiogram changes. An extensive workup revealed the patient had gallstones, however, her hypertension did not resolve with pain control and, ultimately, cholecystectomy. The remainder of her evaluation confirmed the diagnosis of poststreptococcal glomerulonephritis, and her blood pressure was, eventually, controlled with 3 medications: clonidine, isradipine, and amlodipine. Over the ensuing 2 years, these were weaned with no recurrent hypertensive episodes. Although studies have shown extended release Metoprolol to be a safe and effective treatment in children with established hypertension, to the best of our knowledge, it has not been studied in a pediatric emergency setting.
Collapse
Affiliation(s)
- Kirk Liesemer
- Department of Pediatrics, Madigan Army Medical Center, Tacoma,WA, USA.
| | | |
Collapse
|
36
|
Abstract
Acute kidney injury (AKI; previously called acute renal failure) is characterized by a usually reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to appropriately regulate fluid and electrolyte homeostasis. The incidence of AKI in children appears to be increasing and the etiology of AKI over the past decades has shifted from primary renal disease to multifactorial causes, particularly in hospitalized children. Renal failure can be divided into prerenal failure, intrinsic renal disease including vascular insults, and obstructive uropathies. The history, physical examination, and laboratory studies including a urinalysis and radiographic studies can establish the likely cause(s) of AKI. Once intrinsic renal failure has become established, management of the metabolic complications of AKI requires meticulous attention to fluid balance, electrolyte status, acid-base balance, and nutrition. Many children with AKI will need renal replacement therapy to remove endogenous and exogenous toxins and to maintain fluid, electrolyte, and acid-base balance until renal function improves. Renal replacement therapy may be provided by peritoneal dialysis (PD), intermittent hemodialysis (HD), or hemofiltration with or without a dialysis circuit. Many factors--including the age and size of the child, the cause of renal failure, the degree of metabolic derangements, blood pressure, and nutritional needs--are considered in deciding when to initiate renal replacement therapy and which modality of therapy to use. The prognosis of AKI is highly dependent on the underlying etiology of the AKI. Children who have AKI as a component of multisystem failure have a much higher mortality rate than children with intrinsic renal disease. Recovery from intrinsic renal disease is also highly dependent on the underlying etiology of the AKI. Children who have experienced AKI from any cause are at risk for late development of renal failure long after the initial insult. Such children need life-long monitoring of their renal function, blood pressure, and urinalysis.
Collapse
Affiliation(s)
- Sharon P Andreoli
- Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University Medical Center, Indianapolis, Indiana, USA.
| |
Collapse
|
37
|
Trachtman H, Hainer JW, Sugg J, Teng R, Sorof JM, Radcliffe J. Efficacy, safety, and pharmacokinetics of candesartan cilexetil in hypertensive children aged 6 to 17 years. J Clin Hypertens (Greenwich) 2009; 10:743-50. [PMID: 19090875 DOI: 10.1111/j.1751-7176.2008.00022.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This 4-week randomized, double blind, placebo-controlled study (N=240), 1-year open label trial (N=233), and single-dose pharmacokinetic study (N=22) evaluated candesartan cilexetil (3 doses) in hypertensive children aged 6 to 17 years. Seventy-one percent were 12 years of age or older, 71% were male, and 47% were black. Systolic (SBP)/diastolic (DBP) blood pressure declined 8.6/4.8-11.2/8.0 mm Hg with candesartan and 3.7/1.8 mm Hg with placebo (P<.01 compared to placebo for SBP and for the mid and high doses for DBP; placebo-corrected 4.9/3.0-7.5/6.2 mm Hg). The slopes for dose were not, however, different from zero (P>.05). The response rate (SBP and DBP <95th percentile) after 1 year was 53%. The pharmacokinetic profiles in 6- to 12- and 12- to 17-year-olds were similar and were comparable to adults. Eight candesartan patients discontinued treatment because of an adverse event. Candesartan is an effective, well-tolerated antihypertensive agent for children aged 6 to 17 years and has a pharmacokinetic profile that is similar to that in adults.
Collapse
Affiliation(s)
- Howard Trachtman
- Division of Pediatric Nephrology, Schneider Children's Hospital, New Hyde Park, NY, USA
| | | | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Flynn JT. Hypertension in the young: epidemiology, sequelae and therapy. Nephrol Dial Transplant 2008; 24:370-5. [PMID: 18996836 DOI: 10.1093/ndt/gfn597] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
|
40
|
Flynn JT, Meyers KE, Neto JP, de Paula Meneses R, Zurowska A, Bagga A, Mattheyse L, Shi V, Gupte J, Solar-Yohay S, Han G. Efficacy and Safety of the Angiotensin Receptor Blocker Valsartan in Children With Hypertension Aged 1 to 5 Years. Hypertension 2008; 52:222-8. [PMID: 18591457 DOI: 10.1161/hypertensionaha.108.111054] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Joseph T. Flynn
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Kevin E.C. Meyers
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Jose Pacheco Neto
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Rejane de Paula Meneses
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Aleksandra Zurowska
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Arvind Bagga
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Lionel Mattheyse
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Victor Shi
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Jitendra Gupte
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Susan Solar-Yohay
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| | - Guangyang Han
- From the Division of Nephrology (J.T.F.), Children’s Hospital and Regional Medical Center, Seattle, Wash; Division of Nephrology (K.E.C.M.), Children’s Hospital of Philadelphia, Pa; Department of Pediatrics (J.P.N.), Instituto Materno Infantil de Pernambuco, Recife, Pernambuco, Brazil; Centro de Nefrolog Ped do Parana-Hosp (R.d.P.M.), Curitibal, Brazil; Department of Pediatric and Adolescent Nephrology and Hypertension (A.Z.), Gdansk University Medical School, Gdansk, Poland; Department of
| |
Collapse
|
41
|
|
42
|
Flynn JT. Pediatric hypertension: recent trends and accomplishments, future challenges. Am J Hypertens 2008; 21:605-12. [PMID: 18437129 DOI: 10.1038/ajh.2008.159] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Publication of the Fourth Report on high blood pressure (BP) in children and adolescents by the National High BP Education Program (NHBPEP) in 2004 has been followed by a remarkable increase in interest in pediatric hypertension. New data have emerged on the epidemiology of hypertension in the young, the influence of the childhood obesity epidemic on BP, how ambulatory BP monitoring (ABPM) can be used in evaluating elevated BP and the extent of hypertensive target-organ damage in the pediatric age group. Exciting new information on drug treatment of pediatric hypertension has been produced by industry-sponsored clinical trials of antihypertensive medications spurred by the FDA Modernization Act (FDAMA) and successor legislation. Despite these trends, recognition of elevated BP in children and adolescents by primary care providers remains problematic. This article will highlight these and other aspects of pediatric hypertension, hopefully providing a snapshot of where we are in early 2008, and pointing out areas where further work is needed in order to reduce the future burden of adult cardiovascular disease.
Collapse
|
43
|
Tagliari MP, Stulzer HK, Murakami FS, Kuminek G, Valente B, Oliveira PR, Segatto Silva MA. Development and Validation of a Stability-Indicating LC Method to Quantify Hydrochlorothiazide in Oral Suspension for Pediatric Use. Chromatographia 2008. [DOI: 10.1365/s10337-008-0546-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
44
|
|
45
|
Lee EH, Yim HE, Jang GY, Yoo KH, Son CS, Hong YS, Lee JW. Evaluating and managing hypertension in children: a survey of Korean cardiologists and nephrologists. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.9.992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eun Hee Lee
- Department of Pediatrics, Korea University, Seoul, Korea
| | - Hyung Eun Yim
- Department of Pediatrics, Korea University, Seoul, Korea
| | - Gi Young Jang
- Department of Pediatrics, Korea University, Seoul, Korea
| | - Kee Hwan Yoo
- Department of Pediatrics, Korea University, Seoul, Korea
| | - Chang Sung Son
- Department of Pediatrics, Korea University, Seoul, Korea
| | | | - Joo Won Lee
- Department of Pediatrics, Korea University, Seoul, Korea
| |
Collapse
|