Antihypertensive agents: a long way to safe drug prescribing in children

Abstract

Recently updated clinical guidelines have highlighted the gaps in our understanding and management of pediatric hypertension. With increased recognition and diagnosis of pediatric hypertension, the use of antihypertensive agents is also likely to increase. Drug selection to treat hypertension in the pediatric patient population remains challenging. This is primarily due to a lack of large, well-designed pediatric safety and efficacy trials, limited understanding of pharmacokinetics in children, and unknown risk of prolonged exposure to antihypertensive therapies. With newer legislation providing financial incentives for conducting clinical trials in children, along with publication of pediatric-focused guidelines, literature available for antihypertensive agents in pediatrics has increased over the last 20 years. The objective of this article is to review the literature for safety and efficacy of commonly prescribed antihypertensive agents in pediatrics. Thus far, the most data to support use in children was found for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB). Several gaps were noted in the literature, particularly for beta blockers, vasodilators, and the long-term safety profile of antihypertensive agents in children. Further clinical trials are needed to guide safe and effective prescribing in the pediatric population.

In vitro antioxidant and antihypertensive properties of sesame seed enzymatic protein hydrolysate and ultrafiltration peptide fractions

“…Owing to the global impact of hypertension, many studies have investigated antihypertensive medications and new therapeutic alternatives from food sources (Muntneret al, 2019; Shi et al., 2017). Currently, various types of antihypertensive medications have been developed including angiotensin‐converting enzyme (ACE) inhibitors, beta‐blockers and calcium channel blockers owing to the many physiological mechanisms of blood pressure control involving cardiac output, peripheral vascular resistance and circulating blood volume (Siddiqi & Shatat, 2020). These antihypertensive drugs when extensively used for the treatment of hypertension may result in adverse side effects (Niaz et al., 2017; Pal & Shukla, 2003).…”

Congenital Heart Disease: The State-of-the-Art on Its Pharmacological Therapeutics

“…ARBs, such as valsartan and losartan, directly inhibit angiotensin II receptors [53]. Furthermore, the inhibition of the final phase of the RAAS system by ARBs provides a more efficient blockade of cardiovascular effects of angiotensin II with fewer side effects than ACEIs (Table 3) [49]. Specifically, their primary indication is for children who are intolerant to ACEIs [14].…”

The Bioequivalence Between Valsartan Oral Solution and Suspension Formulations Developed for Pediatric Use

“…7 Valsartan and candesartan were ef-ficacious and well tolerated in children aged ≥1 year [9][10][11][12] and are the only ARBs approved for this age group. 7,13 It is crucial to consider child-friendly formulations in children aged <6 years as they may experience challenges with swallowing solid oral formulations such as tablets and capsules. 14 Valsartan is available as suspension and oral solution for use in pediatric patients.…”

“…7 However, compared to ACEIs, ARBs have the advantages of once-daily dosing and a better safety profile. 7,8 Most ARBs like losartan, valsartan, and olmesartan are indicated for children aged 6 to 19 years with hypertension. 7 Valsartan and candesartan were ef-ficacious and well tolerated in children aged ≥1 year [9][10][11][12] and are the only ARBs approved for this age group.…”

“…7,8 Most ARBs like losartan, valsartan, and olmesartan are indicated for children aged 6 to 19 years with hypertension. 7 Valsartan and candesartan were ef-ficacious and well tolerated in children aged ≥1 year [9][10][11][12] and are the only ARBs approved for this age group. 7,13 It is crucial to consider child-friendly formulations in children aged <6 years as they may experience challenges with swallowing solid oral formulations such as tablets and capsules.…”