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 .
Effect of Microalbuminuria Lowering on Regression of Left Ventricular Hypertrophy in Children and Adolescents with Essential Hypertension
Microalbuminuria ( MA ) is associated with increased cardiovascular risk in adult hypertensive patients , but no study has specifically examined the effects of MA lowering on regression of left ventricular hypertrophy ( LVH ) among pediatric patients with hypertension . Fifty-five patients with essential hypertension , 11–19 years old , were prospect ively studied . All patients received concomitant therapy of hydrochlorothiazide and angiotensin-converting enzyme inhibitor . Five patients also required angiotensin receptor blocker to achieve the blood pressure goal . Baseline and 12-month follow-up measures of left ventricular mass index ( LVMI ) , determined by echocardiography and urine microalbumin/creatinine ratio ( MA/Cr ) , were collected . MA was defined as MA/Cr > 30 μg/mg . LVH was defined as LVMI > 38.6 g/m2.7 . The primary end points were reductions in MA and LVMI of 25 % or more . Weight ( r = 0.83 ) , body surface area ( r = 0.85 ) , body mass index ( BMI ) ( r = 0.86 ) , systolic blood pressure ( SBP ) ( r = 0.57 ) , diastolic blood pressure ( DBF ) ( r = 0.49 ) , mean arterial pressure ( r = 0.53 ) and MA ( r= 0.87 ) were all univariate correlates of LVMI . In a multiple regression analysis , MA , BMI and SBP were significant correlates of LVMI . MA alone explained 76 % of the variance of LVMI , whereas BMI and SBP explained only 1.6 and 0.4 % of the variance , respectively . MA was the most significant correlate of follow-up LVMI after BMI and SBP were included in the overall multiple regression models . Thus , MA is a strong predictor of LVH in hypertensive children and adolescents . MA lowering halts the progression of LVH or induces its regression
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 .