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 .
Combined low-dose medication and primary intervention over a 30-month period for sustained high blood pressure in childhood.
Studies of the pathobiologic consequences of high blood pressure in childhood , as well as those following blood pressure levels into young adulthood , indicate that early intervention in the natural history of essential hypertension is warranted . In an exploratory study of the concept , 95 children out of 1604 ( aged 8 to 18 years ) , who persistently scored higher than the 90th percentile for blood pressure over a 4-month period , considering the race , sex , and height of the children , were studied . Five series of replicate measurements with 30 total observations were obtained . Children with evidence of secondary hypertension were excluded . The study children were r and omly divided into treatment ( n = 48 ) and high-comparison ( n = 47 ) groups . Treatment consisted of low-dose combined drug therapy ( propranolol and chlorthalidone ) with an educational program directed towards hypertension and dietary and exercise modification . Monthly follow-up was continued for 30 months . Significant systolic ( -3.59 mm Hg ) and diastolic ( -1.73 mm Hg ) changes were noted up to 30 months ( p less than 0.05 ) with minimal side effects . Furthermore , analyses suggested that the blood pressure change , at least in the first month , was mostly attributable to drug therapy . Moreover , the mechanism of blood pressure change appeared to be race-specific , with whites having pulse rate changes and blacks having significant weight changes , which were associated with blood pressure change . This trial shows further research is warranted to determine optimum approaches for early treatment of essential hypertension to prevent future hypertensive disease
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 .