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 .
Better renoprotective effect of angiotensin II antagonist compared to dihydropyridine calcium channel blocker in childhood.
BACKGROUND The dihydropyridine calcium channel blocker amlodipine and the angiotensin II antagonist irbesartan effectively reduce blood pressure in hypertensive children . METHODS Eligible for the open-label , r and omized study were nephropathic children between 6.0 and 18 years of age with plasma creatinine < 177 micromol/L , overt proteinuria , untreated arterial hypertension ( systolic , 5 to 30 mm Hg ; and diastolic , 1 to 15 mm Hg;>95th centile ) and stable immunosuppressive treatment . The initial dose of amlodipine was 5 mg ( body weight , 20 to 40 kg ) and 10 mg ( body weight,>40 kg ) , respectively , that of irbesartan , which was 75 mg ( body weight , 20 to 40 kg ) and 150 mg ( body weight,>40 kg ) , respectively . The dosage was doubled if necessary . RESULTS A total of 26 children aged 6.1 to 17 years were allocated to receive either amlodipine ( N = 13 ) or irbesartan ( N = 13 ) for 16 weeks . Severe edema and headache occurred in two patients on amlodipine who withdrew from the study . No adverse experiences were noted in patients given irbesartan . Amlodipine [ by 12 ( 10 to 14)/7 ( 5 to 10 ) mm Hg ; median and interquartile range , respectively ] and irbesartan [ by 13 ( 9 to 16)/9 ( 7 to 11 ) mm Hg , respectively ] reduced blood pressure ( P < 0.01 ) in a similar fashion . Heart rate , plasma sodium , and creatinine did not change . Irbesartan slightly increased plasma potassium [ by 0.1 ( 0.0 to 0.2 ) mmol/L ; P < 0.05 ] . Plasma albumin and the urinary albumin/creatinine ratio were similar before and with amlodipine . On the contrary , irbesartan increased plasma albumin [ by 4 ( 3 to 5 ) g/L ; P < 0.03 ] and decreased the urinary albumin/creatinine ratio [ by 242 ( 68 to 312 ) mg/mmol ; P < 0.03 ] . CONCLUSION The study demonstrates that in children the effect of angiotensin II antagonists on proteinuria is better than that of dihydropyridine calcium channel blockers
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 .