Pharmacological Treatment of Arterial Hypertension in Children and Adolescents

Abstract

Pharmacological treatment is indicated in children and adolescents with hypertension unresponsive to lifestyle modifications, but there is not enough evidence to recommend 1 class of antihypertensive drugs over others. We performed a network meta-analysis to compare the results of available randomized clinical trials on pharmacological treatment of pediatric hypertension. From a total of 554 potentially relevant studies, 13 randomized placebo-controlled clinical trials enrolling ≥50 patients and a follow-up ≥4 weeks were included. The reduction of systolic blood pressure (SBP) and diastolic BP (DBP) after treatment were the coprimary end points. A total of 2378 pediatric patients, with a median age of 12 years, were included in the analysis. After a median follow-up of 35 days, lisinopril and enalapril were found to be superior to placebo in reducing SBP and DBP, whereas only for DBP, losartan was found to be superior to placebo and lisinopril and enalapril were found to be superior to eplerenone. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were associated with a greater SBP and DBP reduction compared with placebo, likewise the mineralocorticoid receptor antagonist was inferior to angiotensin-converting enzyme inhibitors in DBP reduction. The analysis was adjusted for study-level mean age, percentage of women, mean baseline blood pressure, and mean weight, only the latter significantly affected DBP reduction. According to the present analysis, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers could represent the best choice as antihypertensive treatment for pediatric hypertension. However, because of the paucity of available data for the other classes of antihypertensive drugs, definitive conclusions are not allowed and further randomized controlled trials are warranted.

Hipertensão arterial na infância: uma revisão de literatura

“…Estudos conduzidos pela Organização Mundial de Saúde (OMS) projetam que, em 2025, haverá 75 milhões de crianças obesas ao redor do mundo, fator que, somado a outros fatores genéticos e ambientais, pode desencadear a expressão de níveis pressóricos elevados. Adicionalmente, dados recentes da Europa demonstram que os números de casos de HA aumentam ainda mais entre crianças com sobrepeso ou obesidade, alcançando um índice de 22% de prevalência (Burrello et al, 2018).…”

Antihypertensive drugs use over a 5-year period among children and adolescents in Beijing, China

“…[31] It is effective in reducing blood pressure and beneficial in protecting heart function, with few reported side effects. [32] Dobson et al [26] reported that the most commonly prescribed drug class was ACEIs, followed by β-receptor blockers, CCBs, and α-receptor blockers in US children aged 2 to 18 years. Yoon et al [33] and Binka et al [34] found that ACEIs were the most frequently prescribed monotherapy for adolescents in the US.…”

Cardiovascular Risk Factors in Children

“…First-line treatment, especially in obese, is lifestyle intervention with salt restriction and weight loss. Pharmacological treatment is indicated in hypertensive children unresponsive to lifestyle modifications, as well as in children with symptomatic hypertension, secondary hypertension, target organ damage, diabetes mellitus or chronic kidney disease [17,18]. Antihypertensive treatment is started with the lowest dose of a single drug and titrated if needed until maximum recommended dose is reached.…”

“…If blood pressure is still elevated, the second drug can be added and up-titrated. The choice of particular antihypertensive drug is partly dependent on underlying etiology, partly on other relevant factors, such as end organ damage, concurrent disorders, side effects and clinician's preference [17,18].…”