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, open-label, dose-response study of losartan in hypertensive children.
BACKGROUND AND OBJECTIVES Once-daily losartan reduces BP in a dose-dependent manner and is well tolerated in hypertensive children aged 6 - 16 years . This study assessed the dose-response relationship , safety , and tolerability of losartan in hypertensive children aged 6 months to 6 years . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This was a 12-week , r and omized , open-label , dose-ranging study , with a 2-year extension . Patients were r and omized to losartan at the following dosages : 0.1 mg/kg per day ( low ) , 0.3 mg/kg per day ( medium ) , or 0.7 mg/kg per day ( high ) . Losartan was titrated to the next dose level ( to a 1.4 mg/kg per day maximum dosage , not exceeding 100 mg/d , which was not one of the three original doses offered at r and omization ) at weeks 3 , 6 , and 9 for patients who did not attain their goal BP and were not taking the highest dose . Dose response was evaluated by analyzing the slope of change in sitting systolic BP ( SBP ; primary end point ) and diastolic BP ( DBP ; secondary end point ) after 3 weeks compared with baseline . Adverse events ( AEs ) were recorded throughout . RESULTS Of the 101 patients r and omized , 99 were included in the analysis ( low dose , n=32 ; medium dose , n=34 ; and high dose , n=33 ) . Mean sitting BP decreased from baseline in the low- , medium- , and high-dose groups by 7.3 , 7.6 , and 6.7 mmHg , respectively , for SBP and 8.2 , 5.1 , and 6.7 mmHg , respectively , for DBP after 3 weeks . No dose-response relationship was established by the slope analysis on SBP ( P=0.75 ) or DBP ( P=0.64 ) . The BP-lowering effect was observed throughout the 2-year extension . The incidence of AEs was low and comparable between groups . CONCLUSIONS Hypertensive children aged 6 months to 6 years treated with losartan 0.1 - 0.7 mg/kg per day had clinical ly significant decreases from baseline in SBP and DBP , yet no dose-response relationship was evident . Losartan , at a dosage up to 1.4 mg/kg per day , was well tolerated
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 .