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 .
Efficacy, safety and pharmacokinetics of candesartan cilexetil in hypertensive children from 1 to less than 6 years of age
Background Few antihypertensive drugs are available in appropriate formulations for infants . Method We investigated c and esartan cilexetil liquid suspension in a 4-week , r and omized double-blind dose-ranging study followed by a 1-year open-label treatment phase ( NCT00244621 ) . The drug was administered at 0.05 , 0.2 or 0.4 mg/kg per day in 93 hypertensive children aged 1–5 years , of whom 74 had underlying renal disorders . Results A single-dose pharmacokinetic profile was obtained in 10 patients . At 4 weeks , SBP declined dose dependently by 6 , 9 and 12 mmHg in the three dose groups ( P = 0.01 ) , and DBP by 5 , 8 and 11 mmHg ( P = 0.03 ) . During the 1-year follow-up , responder rates ( both SBP and DBP < 95th percentile ) ranged from 48.2 to 54.1 % . C and esartan lowered the blood pressure regardless of age , sex , BMI or cause of hypertension . The pharmacokinetic profile was independent of age , sex and weight , and was similar to that in older children and adults . In participants with proteinuric renal disease ( urinary albumin/creatinine ratio > 30 mg/g ) , a 57 % median decline in albumin/creatinine ratio was observed at 4 weeks , which was dose related ( P = 0.007 ) and persisted with long-term administration . There were no notable electrocardiographic or laboratory abnormalities . A mild decline in estimated glomerular filtration rate observed at 4 weeks was not progressive with long-term dosing . C and esartan was generally well tolerated ; two patients withdrew for adverse events ( fatigue and worsening glomerulopathy ) . One patient died , probably from acute-on-chronic renal failure . Conclusion C and esartan cilexetil dose-dependently decreases blood pressure and albuminuria  in hypertensive infants and 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 .