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 .
Efficacy and safety of valsartan compared to enalapril in hypertensive children: a 12-week, randomized, double-blind, parallel-group study
Objective This study compares efficacy and safety of valsartan with enalapril in hypertensive children aged 6–17 years . Method This was a 12-week , r and omized , double-blind , parallel-group , active-controlled study . After a single-blind placebo run-in period ( 4–28 days ) , patients with mean sitting systolic blood pressure ( BP ) ( MSSBP ) at least 95th percentile for age , gender , and height were r and omized to receive half the assigned dose for first week , and force-titrated to full dose for 11 weeks ( ≥18 to < 35 kg – valsartan : 80 mg , enalapril : 10 mg ; ≥35 to < 80 kg – valsartan : 160 mg , enalapril : 20 mg ; ≥80 to ⩽160 kg – valsartan : 320 mg , enalapril : 40 mg ) . The primary efficacy variable was changed from baseline in MSSBP to show noninferiority of valsartan to enalapril . Other efficacy variables were changed from baseline in MSDBP , SBP control rate , and 24-h ambulatory BP parameters . Results Of 300 r and omized patients , 281 ( 94 % ) completed the study . At week 12 , MSSBP reductions were similar for valsartan and enalapril ( primary endpoint of noninferiority , P < 0.0001 ) . Least square mean BP reductions from baseline of −15.4/−9.4 mmHg were observed for valsartan compared with −14.1/−8.5 mmHg for enalapril . A similar proportion of patients achieved SBP control  ( valsartan : 67 % ; enalapril : 70 % ) . In the subset of patients who underwent ambulatory BP assessment s , valsartan provided greater reductions  than enalapril  in mean 24-h SBP  ( valsartan : −9.8 mmHg , enalapril : −7.2 mmHg : P = 0.03 ) . The overall incidence of AEs was similar ( valsartan 60 % , enalapril 58 % ) with headache , cough , and nasopharyngitis reported most frequently . Conclusions Valsartan and enalapril provided comparable BP reductions and effective BP control and were well tolerated in hypertensive children aged 6–17 years
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 .