Safety of the newer antihypertensive agents in children

Pharmacologic Treatment of Pediatric Hypertension

Prevalence of hypertension is increasing in children and adolescents. Uncontrolled hypertension in children not only causes end organ damage but also increases the risk of adult hypertension and cardiovascular disease. Clinical trials have proven efficacy of antihypertensive medications in children. These medications are well tolerated by children with acceptable safety profile. The choice of agent is usually driven by underlying etiology of hypertension, profile of its side effects, and clinician's preference. This article will review currently available pediatric data on mechanism of action, common adverse effects, pediatric indication, recent clinical trial, and newer drugs in the common classes of antihypertensive medications.

Management of hypertension in children and adolescents

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.

Therapeutic options for the treatment of hypertension in children and adolescents

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.

Efficacy and safety of prolonged amlodipine treatment in hypertensive children

To examine the long-term efficacy and safety of amlodipine in hypertensive children, data on prolonged use (> or = 6 months) of amlodipine in 33 children were reviewed. All children received amlodipine as sole therapy for their hypertension. Causes of hypertension included solid organ transplant (n=19), renal disease (n=7) primary hypertension (n=6), and drug-induced hypertension (n=1). Mean patient age at the start of amlodipine treatment was 9.8+/-4.8 years (range 1.3-16.9); there were 19 boys and 14 girls. Mean duration of amlodipine treatment was 20.4+/-11.5 months (range 6-48). Analysis of blood pressure and dosing data revealed that blood pressure reduction was sustained throughout the period of amlodipine treatment, while amlodipine dose remained stable (mean effective daily dose 0.17+/-0.12 mg/kg). No patient required discontinuation of amlodipine because of adverse effects. This small study suggests that prolonged amlodipine treatment is well tolerated in hypertensive children and provides sustained blood pressure control. Further studies are necessary to determine what effects if any long-term calcium channel blocker treatment has on the growth and development of children with hypertension.