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 .
Clinical trial of extended-release felodipine in pediatric essential hypertension
Abstract .Essential hypertension in pediatric patients may require pharmacological treatment . There is a need for efficacious , safe , and well-tolerated antihypertensive agents with a once-a-day dosing regimen in children and adolescents . The aim of the trial was to evaluate the dose-response and tolerability of the dihydropyridine calcium channel blocker , felodipine extended-release tablets ( felodipine ER ) , given once daily to pediatric patients with essential hypertension . A r and omized double-blind , parallel-group , multi-center clinical study comparing felodipine ER ( 2.5 , 5 , or 10 mg once daily ) and placebo was performed on pediatric patients with a baseline systolic ( SBP ) or diastolic blood pressure ( DBP ) above the 95th percentile for age , sex , and height . Of 133 r and omized patients , 128 ( 96.2 % ) completed the 3 weeks of double-blind treatment . The study population included 50 % children 6–12 years of age or Tanner stage ≤3 , 39 % black , and 40 % female patients . All doses of felodipine ER and placebo  decreased both SBP and DBP . The 5-mg dose of felodipine ER result ed in a significant decline in trough sitting , st and ing , and supine DBP ( placebo-adjusted , −4.6 , −5.06 , and −5.05 mmHg , respectively , P<0.05 ) compared with placebo . However , there was no significant decline in SBP . The 2.5- and 10-mg doses showed no significant differences compared with placebo in lowering BP . The effect of felodipine ER was comparable in patient subgroups by age , race , and gender . The drug was well tolerated . The study failed to show a dose response of felodipine ER in pediatric patients with essential hypertension . This finding might be explained in part by the limitations of study design . The spectrum of side effects in pediatric patients was comparable with that in adults , except for a lower incidence of peripheral edema . Further studies are needed to clarify the role of felodipine ER in the management of children and adolescents with essential hypertension
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 .