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 .
Antiproteinuric effects of enalapril and losartan: a pilot study
In this r and omized double-blind crossover trial we compared the antiproteinuric effects of enalapril and losartan in six children with proteinuria and underlying renal injury . The primary endpoint was reduction in proteinuria during therapy . The study had two 8-week on-drug arms , with a 4-week washout period between . Baseline proteinuria was similar , enalapril 87 mg/m2 per hour and losartan 77 mg/m2 per hour . The mean reduction in proteinuria with enalapril was 48 % ( 37%–57 % ) with a st and ard error of the mean of 3 % ; with losartan it was 31 % ( 14%–52 % ) with a st and ard error of the mean of 7 % . Although there was a significant reduction in proteinuria with the use of both drugs , the difference in reduction of proteinuria , 48 % versus 31 % , was not considered clinical ly significant . Potassium remained below 4.5 mmol/l in all patients . No patient 's creatinine rose more than the st and ard deviation of our assay . Blood pressure ( BP ) control was acceptable in four of the six patients ; two patients had persistently elevated or increased BP on each drug . Side effects were minimal ; none requiring withdrawal , one requiring dose reduction . Studies have shown that angiotensin converting enzyme inhibitors can reduce proteinuria in children with renal disorders . No studies to date have examined the reduction of proteinuria achieved by angiotensin receptor blockers . Our study , although small , suggests that angiotensin receptor blockers may reduce proteinuria as effectively , and as safely , as angiotensin converting enzyme inhibitors
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 .