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 .
The efficacy and safety of the novel aldosterone antagonist eplerenone in children with hypertension: a randomized, double-blind, dose-response study.
OBJECTIVES To determine the efficacy and safety of eplerenone therapy in children with hypertension . STUDY DESIGN A total of 304 children age 4 - 16 years with systolic blood pressure ( SBP ) > or=95th percentile were r and omized to low-dose ( 25 mg daily ) , middle-dose ( 25 mg twice daily ) , or high-dose ( 50 mg twice daily ) eplerenone ( phase A ) , then rer and omized to active therapy or placebo for another 4 weeks ( phase B ) . The primary endpoint was change in SBP in phase B. RESULTS During phase A , mean SBP decreased from baseline by 8 mm Hg , and diastolic blood pressure ( DBP ) decreased by up to 3.8 mm Hg ; no dose-response relationship was demonstrated . Mean differences in SBP from placebo during phase B were -2.61 for the low-dose group , + 2.32 for the middle-dose group , and -2.76 mm Hg for the high-dose group ; only the reduction in the high-dose group was statistically significant ( P = .048 ) . No significant effects on DBP of eplerenone therapy relative to placebo were detected . Eplerenone was well tolerated , with a rate of adverse events comparable to that of placebo . CONCLUSIONS Short-term treatment with eplerenone reduced blood pressure in children with hypertension and had acceptable tolerability
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 .