The safety and use of short-acting nifedipine in hospitalized hypertensive children

Abstract

Recent reports suggest that calcium channel blockers are harmful in the treatment of acute hypertension in adults. However, short-acting nifedipine is an effective and useful medication in pediatric hypertension and is currently utilized for hypertensive emergencies. This study will address these safety concerns in hypertensive children. Medical records (from five Canadian pediatric hospitals) of all pediatric hypertensive hospitalized children who were treated with short-acting nifedipine from January 1995 to December 1998 were retrospectively reviewed for patient demographics, dosing regimen, use of concomitant medications, co-morbid conditions, and presence/absence of minor and serious adverse events. Final data were extracted from 182 patients. Each patient had an average of 2.6 episodes of hypertension in hospital that required treatment, totaling 477 episodes. Within the 477 episodes, 1,162 doses of short-acting nifedipine were administered. The mean dose was 0.22 mg/kg (range 0.043-0.67 mg/kg, median 0.19 mg/kg) with 55.6% (260/468 episodes) receiving the drug via the sublingual route. Hypertension resolved in 85.5% (408/477) of the episodes. There were only 29 of 574 (5.1%) minor adverse events that were definitely or probably related to short-acting nifedipine administration. Two patients experienced a serious adverse event that involved of a reduction in blood pressure of more than 40%, but neither had any symptomatology from the serious adverse event and recovered spontaneously within 2 h. Short-acting nifedipine in hypertensive, hospitalized children appears to be a safe and efficacious medication with minimal side effects.

Effects of antihypertensive drugs on blood pressure and proteinuria in childhood

“…We excluded reports which deal with the pharmacokinetics of antihypertensive agents [2][3][4][5][6][7][8][9], with the management of hypertensive emergency, neonatal hypertension or heart failure, or with the management of minimal range albuminuria in diabetes mellitus [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], or include fewer than 10 individuals [25][26][27][28][29][30][31][32][33][34][35][36]. Trials examining antihypertensive drugs for periods less than 4 weeks [37][38][39], reports not describing the outcome of interest [40][41][42][43][44][45][46][47][48] or describing the effect of a substance added to another, both with the same mechanism of action …”

Old Habits Die Hard: A Nationwide Utilization Study of Short-Acting Nifedipine in Taiwan

“…While even a low dose of sublingual nifedipine could induce risk of myocardial or cerebral ischemia in elderly patients [8], [18], the short-acting nifedipine for treating acute hypertension in children was still recommended by some authors [19]–[22]. Because the prevalence of hypertension and hypertensive emergencies was highly related to age, we could hardly observe the PRN use of short-acting nifedipine in children in our study.…”

Hypertensive Emergencies in Children

“…Oral or sublingual administration of nifedipine is associated with erratic blood pressure response, with precipitous drop in blood pressure reported to cause severe hypotension, cerebrovascular ischaemia and acute myocardial infarction [22]. However, the risk of adverse effects is low at smaller doses (0.1-0.25 mg/kg); and nifedipine has been safely and effectively used in children with hypertensive emergencies in situations where intravenous therapy is delayed [23,24]. Clonidine, a centrally-acting α2-adrenergic agonist that reduces BP by reducing cerebral sympathetic output, has been noted to be useful when given orally in the acute setting, particularly in hemodialysis patients [25].…”