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 .
Antihypertensive and renoprotective efficacy and safety of losartan. A long-term study in children with renal disorders.
BACKGROUND Hypertension is a major risk factor for progressive renal failure . We assessed the long term efficacy and safety of losartan in lowering blood pressure ( BP ) and in preserving renal function in hypertensive children with chronic renal disorders . METHODS Losartan was used in 45 consecutive hypertensive children with chronic renal parenchymal disorders and mean glomerular filtration rate ( GFR ) 99.4 mL/min/1.73 m(2 ) . Of the children , 21 had hypertension alone ( H ) and 24 had both hypertension and proteinuria ( H+P ) . Assessment was done at baseline and at preselected time points : visit I , < 0.25 years ; visit II , > /=0.25 and < 0.5 year;visit III , 0.5 to 1.0 year ; and visit IV > 1 year . Both BP control and GFR were the principal outcome measures , and proteinuria was a secondary outcome measure . RESULTS The mean age was 12.85 years and follow-up was 2.42 years ( visit IV ) . Compared with baseline the systolic , diastolic , and mean arterial BP ( MABP ) fell by 9 to 12 mm Hg ( all P < .01 ) in visit I. Diastolic BP and MABP remained significantly lower in all visits ( P < .05 to .001 ) , whereas systolic BP was not statistically lower in visit II . In visit IV the proportion of normotensive children increased significantly compared with baseline ( P < .03 for systolic BP , P < .0004 for diastolic BP ) . In the H+P subgroup , optimal reduction in proteinuria ranging from 66 % to 71 % occurred in visits II to IV ( all P < .01 ) . Mean GFR declined at a rate of 9.3 mL/min/1.73 m(2 ) /year before starting losartan , and 1.4 mL/min/1.73 m(2 ) /year subsequently ( P = NS ) . On long term follow-up , GFR fell by 15.9 mL/min/1.73 m(2 ) in the H subgroup and by 5.5 mL/min/1.73 m(2 ) in the H+P subgroup ( P = NS ) . There was no correlation between BP measures and GFR or between the magnitude of BP lowering and proteinuria . Adverse effects ( one serious ) led to discontinuation of losartan in five children ( 11 % ) . CONCLUSIONS Losartan therapy was associated with prolonged and sustained antihypertensive and renoprotective benefits in children with a variety of chronic renal parenchymal disorders . Such benefit may be more pronounced in children with combined hypertension and proteinuria . The agent was well tolerated in the majority of the children
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 .