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 .
Randomized, double-blind, controlled study of losartan in children with proteinuria.
BACKGROUND AND OBJECTIVES No large , r and omized , double-blind trials in children with proteinuria treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers have previously been reported . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This 12-week , double-blind , multinational study investigated the effects of losartan 0.7 to 1.4 mg/kg per day compared with placebo ( normotensive stratum ) or amlodipine 0.1 to 0.2 mg/kg per day up to 5 mg/d ( hypertensive stratum ) on proteinuria ( morning-void urinary protein-creatinine ratio , baseline > or = 0.3 g/g ) in 306 children up to 17 years of age . RESULTS Twelve weeks of treatment with losartan significantly reduced proteinuria compared with amlodipine/placebo : losartan -35.8 % ( 95 % confidence interval : -27.6 % to -43.1 % ) versus amlodipine/placebo 1.4 % ( 95 % confidence interval : -10.3 % to 14.5 % ) , P < or = 0.001 . Significance remained after adjustment for differences across treatment groups in change in BP ( losartan produced incremental systolic and diastolic BP reductions versus amlodipine of 5.4 and 4.6 mmHg , respectively ; and versus placebo of 3.8 and 4.0 mmHg , respectively ) . Proteinuria reduction was consistently observed in the normotensive ( -34.4 % losartan ; 2.6 % placebo ) and hypertensive ( -41.5 % losartan ; 2.4 % amlodipine ) strata , and in all prespecified subgroups , including age , gender , race , Tanner stage , weight , prior therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers , as well as among the most common etiologies of proteinuria . Adverse event incidence was low and comparable in all groups . CONCLUSIONS Losartan significantly lowered proteinuria and was well tolerated after 12 weeks in children aged 1 to 17 years with proteinuria with or without hypertension , a population that has not previously been rigorously studied
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 .