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 double-blind, placebo-controlled, dose-response study of the effectiveness and safety of lisinopril for children with hypertension.
BACKGROUND Despite widespread use in hypertensive children , the safety and effectiveness of lisinopril had not been previously tested in a controlled study . METHODS This study explored the dose-response relationship and safety of lisinopril in 115 hypertensive children , aged 6 to 16 years . Patients were r and omized in a double-blind fashion for 2 weeks to one of three doses by body weight at baseline : < 50 kg : low ( 0.625 mg ) , middle ( 2.5 mg ) , high ( 20 mg ) , and > or = 50 kg : low ( 1.25 mg ) , middle ( 5 mg ) , high ( 40 mg ) . The dose-response for lisinopril was evaluated by analyzing the change in slope in sitting diastolic and systolic blood pressure ( BP ) by dose after 2 weeks of therapy compared to baseline . Patients then entered a double-blind withdrawal , where patients were either switched to placebo or continued their current lisinopril treatment for up to 2 weeks . Patients completed period II when their BP returned to baseline . Antihypertensive effectiveness , between placebo and lisinopril was determined for all doses . Adverse events were carefully monitored . RESULTS There was a dose-response relationship between the lowest and each of the higher doses of lisinopril . Blood pressure in the placebo group increased after withdrawal of lisinopril . The dose-response relationship was consistent across all subgroups ( ie , age , Tanner stage , ethnicity , gender ) . CONCLUSIONS Lisinopril , once daily , is an effective and well-tolerated antihypertensive in children aged 6 to 16 years . An initial dose of 0.07 mg/kg , administered once daily , effectively lowered BP within 2 weeks . Blood pressure was reduced in a dose-dependent fashion
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 .