A randomized prospective crossover trial of amlodipine in pediatric hypertension

Abstract

Amlodipine has potential advantages in children since it can be dissolved into a liquid preparation and has a long elimination half-life, allowing for once-daily administration. The objective of this study was to compare the efficacy and compliance of amlodipine with that of standard long-acting calcium channel blockers (felodipine or nifedipine) in hypertensive children. A randomized, prospective, crossover study of 11 hypertensive children (9-17 years of age, 10 renal transplant patients) was performed with electronic monitoring of compliance. Each treatment arm was 30 days. No significant differences were observed in mean systolic (SBP) and diastolic blood pressures (DBP) between amlodipine and the other calcium channel blockers. Using 24-h blood pressure monitoring there were no significant differences over each drug treatment period in both mean day-time and night-time SBP and DBP. Patient compliance was similar in both the amlodipine and the nifedipine/felodipine treatment periods. These data suggest that amlodipine is as effective in pediatric nephrology patients as nifedipine and felodipine. Amlodipine may be optimally suited for treatment of young children because at present it is the only calcium channel blocker which can be administered once daily as a liquid preparation.

Antihypertensive efficacy of amlodipine in children with chronic kidney diseases

“…11,19 The side effects noted in our paediatric patients given amlodipine are similar to those reported in adults and children treated with amlodipine or other dihydropyridines. [1][2][3][4]18,[20][21][22][23] These vasodilators lead in 10 to 20% of patients to one or more of the following: headache, dizziness or lightheadedness, flushing, and peripheral oedema. The peripheral oedema is related to redistribution of fluid from the vascular space into the interstitium, possibly induced by vasodilatation which allows more of the arterial pressure to be transmitted to the capillary circulation.…”

“…Finally dose adjustment is superfluous in renal impairment. [1][2][3][4]16,17 Paediatric use of amlodipine has previously been reported, 12,18,[20][21][22][23] but previous reports have been limited by small patient numbers 12,[20][21][22][23] and rather heterogenous patient populations, that included both in-and outpatients 18,20 or both renal and non renal hypertension. 12,18,20,21 In conclusion the results of the present experience in paediatric outpatients with chronic kidney diseases support the view that amlodipine is an effective and rather well tolerated antihypertensive drug when given once a day in a dosage of 7 to 10 mg/m 2 body surface area and suggest that it has obvious advantages over other dihydropyridines.…”

Hypertension in pediatric patients with chronic kidney disease: management challenges

“…Felodipine (dihydropyridine calcium channel blocker) has also shown promising effects. [105][106][107][108][109][110] Often a single agent will be insufficient to achieve currently recommended targets for BP in children with CKD, and multiple agents may be needed. In order to achieve the recommended target of BP <50th percentile in proteinuric CKD children, as found in the Effect of Strict Blood Pressure Control and ACE Inhibition on Progression of CRF in Pediatric Patients trial, 111 at least 50% of children will require additional agents.…”

Efficacy and safety of prolonged amlodipine treatment in hypertensive children

“…Subjects in this report received amlodipine on average for nearly 2 years, and most for at least 1 year, far longer than in any of the published reports of pediatric amlodipine use to date [3,4,5,6,7,8,9,10]. Amlodipine produced a significant reduction in blood pressure within about 6 weeks after the start of treatment that was sustained for the duration of therapy.…”

“…Given that many hypertensive children have chronic renal disease or other underlying identifiable causes of hypertension, long-term, if not indefinite, antihypertensive therapy will be needed in many such children. Unfortunately, however, the duration of amlodipine treatment in published pediatric series to date has been quite short, usually 6-16 weeks [3,4,5,6,7,8,9,10]. We therefore assessed the long-term efficacy and tolerability of amlodipine use in hypertensive children by studying patients who had received amlodipine treatment for 6 months or longer.…”