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 .
A double-blind, placebo-controlled, dose-response study of the effectiveness and safety of enalapril for children with hypertension.
Despite widespread use to treat childhood hypertension , enalapril has never been studied systematic ally to determine effectiveness , dose response , and safety in a pediatric population . This study was conducted prospect ively in 110 hypertensive children ages 6 to 16 years in two sequential phases . The primary outcome variable for both phases of the study was trough ( 24-h postdose ) sitting diastolic blood pressure . The primary objective of the first phase of the study was to determine whether enalapril lowered blood pressure in children in a dose-dependent manner . During a 2-week , double-blind , r and omized , dose-response period , patients were stratified by weight ( < 50 kg or > or = 50 kg ) , then assigned to one of three dosing groups : low(0.625 or 1.25 mg ) , middle ( 2.5 or 5 mg ) , or high dose ( 20 or 40 mg ) . Reduction in blood pressure was examined as a function of dose ratio ( 1:4:32 ) and on a weight-adjusted basis . On completion of the dose-response phase of the study , patients entered a 2-week , double-blind , r and omized withdrawal to either enalapril or placebo .  Antihypertensive effectiveness , defined as the difference in sitting diastolic blood pressure between the placebo and enalapril groups , was determined . Adverse events were carefully recorded throughout the study . The dose-response relationship for enalapril had a negative slope and was linear over the chosen dosing range , suggesting that larger doses of enalapril were associated with a greater reduction in blood pressure . R and omized withdrawal to active drug orplacebo confirmed the antihypertensive effectiveness of enalapril in the middle- and high-dose groups . The antihypertensive effect of enalapril was maintained across age , gender , race , and Tanner stage . Enalapril appears to be an effective and generally well-tolerated antihypertensive agent in children ages 6 to 16 years . An initial dose of 2.5 mg in children weighing < 50 kg and 5 mg in children weighing > 50 kg ( mean = 0.08 mg/kg ) administered once daily effectively lowered blood pressure within 2 weeks in most patients . Blood pressure was reduced in a dose-dependent fashion , with larger doses result ing in a greater reduction
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 .