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 .
Strict blood-pressure control and progression of renal failure in children.
BACKGROUND Although inhibition of the renin-angiotensin system delays the progression of renal failure in adults with chronic kidney disease , the blood-pressure target for optimal renal protection is controversial . We assessed the long-term renoprotective effect of intensified blood-pressure control among children who were receiving a fixed high dose of an angiotensin-converting-enzyme ( ACE ) inhibitor .  METHODS After a 6-month run-in period , 385 children , 3 to 18 years of age , with chronic kidney disease ( glomerular filtration rate of 15 to 80 ml per minute per 1.73 m(2 ) of body-surface area ) received ramipril at a dose of 6 mg per square meter of body-surface area per day . Patients were r and omly assigned to intensified blood-pressure control ( with a target 24-hour mean arterial pressure below the 50th percentile ) or conventional blood-pressure control ( mean arterial pressure in the 50th to 95th percentile ) , achieved by the addition of antihypertensive therapy that does not target the renin-angiotensin system ; patients were followed for 5 years . The primary end point was the time to a decline of 50 % in the glomerular filtration rate or progression to end-stage renal disease . Secondary end points included changes in blood pressure , glomerular filtration rate , and urinary protein excretion . RESULTS A total of 29.9 % of the patients in the group that received intensified blood-pressure control reached the primary end point , as assessed by means of a Kaplan-Meier analysis , as compared with 41.7 % in the group that received conventional blood-pressure control ( hazard ratio , 0.65 ; confidence interval , 0.44 to 0.94 ; P=0.02 ) . The two groups did not differ significantly with respect to the type or incidence of adverse events or the cumulative rates of withdrawal from the study ( 28.0 % vs. 26.5 % ) . Proteinuria gradually rebounded during ongoing ACE inhibition after an initial 50 % decrease , despite persistently good blood-pressure control . Achievement of blood-pressure targets and a decrease in proteinuria were significant independent predictors of delayed progression of renal disease . CONCLUSIONS Intensified blood-pressure control , with target 24-hour blood-pressure levels in the low range of normal , confers a substantial benefit with respect to renal function among children with chronic kidney disease . Reappearance of proteinuria after initial successful pharmacologic blood-pressure control is common among children who are receiving long-term ACE inhibition . ( Clinical Trials.gov number , NCT00221845 .
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 .