The adverse events associated with the antihypertensive agents were mostly minor and included headaches , dizziness and upper respiratory infections .
The most data are available for c and esartan , for which there is low- quality evidence of a modest lowering effect on blood pressure .
We did not find evidence of a consistent dose response relationship for escalating doses of angiotensin receptor blockers , calcium channel blockers or angiotensin-converting enzyme inhibitors .
All agents appear safe , at least in the short term
BACKGROUND Hypertension is a major risk factor for stroke , coronary artery disease and kidney damage in adults .
There is a paucity of data on the long-term sequelae of persistent hypertension in children , but it is known that children with hypertension have evidence of end organ damage and are at risk of hypertension into adulthood .
The prevalence of hypertension in children is rising , most likely due to a concurrent rise in obesity rates .
In children with hypertension , non-pharmacological measures are often recommended as first-line therapy , but a significant proportion of children will eventually require pharmacological treatment to reduce blood pressure , especially those with evidence of end organ damage at presentation or during follow-up .
A systematic review of the effects of antihypertensive agents in children has not previously been conducted .
OBJECTIVES To determine the dose-related effects of different classes of antihypertensive medications , as monotherapy compared to placebo ; as combination therapy compared to placebo or a single medication ; or in comparisons of various doses within the same class , on systolic or diastolic blood pressure ( or both ) in children with hypertension .
A randomized, placebo-controlled trial of amlodipine in children with hypertension.
OBJECTIVES Evaluation of the efficacy and safety of amlodipine in hypertensive children . STUDY DESIGN A r and omized , double blinded , placebo-controlled , parallel-group , dose-ranging study was conducted at 49 centers in North and South America . The primary end point was the effect of amlodipine on systolic blood pressure ( BP ) ; secondary end points included the effect of amlodipine on diastolic BP , the effect of amlodipine as a function of dose and body size , and evaluation of safety . RESULTS We enrolled 268 hypertensive children ( mean age , 12.1 + /- 3.3 years ) ; 84 ( 31.3 % ) had primary hypertension , and 177 ( 66 % ) were boys .  Amlodipine produced significantly greater reductions in systolic BP than placebo ; these were -6.9 mm Hg for 2.5 mg daily ( P=.045 vs placebo ) and -8.7 mm Hg for 5 mg daily ( P=.005 vs placebo ) . The underlying cause of hypertension had no effect on the response to amlodipine . There was a significant dose-response effect of amlodipine on both systolic and diastolic BP beginning at doses > or = 0.06 mg/kg per day . Systolic BP < or = 95(th ) percentile was achieved in 34.6 % of subjects with systolic hypertension . Amlodipine was well tolerated , with just 6 children withdrawn from treatment because of drug-related adverse events . CONCLUSIONS Amlodipine effectively lowers systolic BP in a dose-dependent manner in hypertensive children who require drug treatment
The adverse events associated with the antihypertensive agents were mostly minor and included headaches , dizziness and upper respiratory infections .
The most data are available for c and esartan , for which there is low- quality evidence of a modest lowering effect on blood pressure .
We did not find evidence of a consistent dose response relationship for escalating doses of angiotensin receptor blockers , calcium channel blockers or angiotensin-converting enzyme inhibitors .
All agents appear safe , at least in the short term
BACKGROUND Hypertension is a major risk factor for stroke , coronary artery disease and kidney damage in adults .
There is a paucity of data on the long-term sequelae of persistent hypertension in children , but it is known that children with hypertension have evidence of end organ damage and are at risk of hypertension into adulthood .
The prevalence of hypertension in children is rising , most likely due to a concurrent rise in obesity rates .
In children with hypertension , non-pharmacological measures are often recommended as first-line therapy , but a significant proportion of children will eventually require pharmacological treatment to reduce blood pressure , especially those with evidence of end organ damage at presentation or during follow-up .
A systematic review of the effects of antihypertensive agents in children has not previously been conducted .
OBJECTIVES To determine the dose-related effects of different classes of antihypertensive medications , as monotherapy compared to placebo ; as combination therapy compared to placebo or a single medication ; or in comparisons of various doses within the same class , on systolic or diastolic blood pressure ( or both ) in children with hypertension .