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, dose-response study of losartan in hypertensive children.
BACKGROUND The aim of this study was to determine the dose-response relationship for losartan , 2.5 to 100 mg , and to assess the safety and tolerability of losartan in hypertensive children 6 to 16 years of age . METHODS This was a multicenter , r and omized , double-blind , dose-response study . In Period 1 , a total of 175 patients were stratified by weight ( < 50 kg and > /=50 kg ) and r and omized to one of three dose groups by stratum ( low , 2.5/5.0 mg ; middle , 25/50 mg ; or high , 50/100 mg ) for 3 weeks . The ratio of the three dose levels for both weight strata was 1:10:20 . In Period 2 , patients in each dose group were r and omized to continue the same treatment or placebo washout for 2 additional weeks . RESULTS In Period 1 , sitting trough diastolic blood pressure ( DBP ) decreased in a dose-dependent manner ( P < .0001 ) . At week 3 , changes in DBP from baseline in the low- , middle- , and high-dose groups were -6.0 mm Hg , -11.7 mm Hg , and -12.2 mm Hg , respectively . In Period 2 , DBP increased significantly in patients who switched from middle- and high-dose losartan to placebo ( mean increase 6.0 mm Hg , P = .003 ) relative to DBP in patients who remained on active treatment ; however , these levels remained stable in those patients who switched from low-dose losartan to placebo ( mean increase 1.1 mm Hg , P = .628 ) . CONCLUSIONS In hypertensive children 6 to 16 years of age , losartan given once daily reduced blood pressure in a dose-dependent fashion . A once-daily starting dose of losartan , 0.75 mg/kg ( maximum 50 mg ) effectively lowered DBP within 3 weeks . Losartan up to a dosage of 1.44 mg/kg ( maximum 100 mg ) once daily is generally well tolerated
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 .