Treatment of primary and secondary hypertension in children

Abstract

The incidence of pediatric hypertension (HTN) is increasing, mainly due to an increase in primary (essential) HTN, or PH. There are only a limited number of studies assessing the characteristics and treatment efficacy of PH versus secondary HTN (SH). We conducted a retrospective analysis of 158 pediatric patients (mean age: 10.8 years; sex ratio: 51.1% female, 48.9% male) with HTN of whom 34.4% had PH and 65.6% had SH. The vast majority were either African-American or Caucasian. Among all patients, therapy induced a significant decrease in systolic blood pressure (SBP) and diastolic BP (DBP) (both p<0.0001). SBP (p<0.0001) and DBP (p=0.002) declined significantly in PH patients. PH and SH patients with a body mass index (BMI) >95th percentile (%) had a significantly higher post-therapy SBP (both p<0.05) than those with a BMI <95th%. SBP declined similarly in PH patients treated with calcium-channel blockers (CCB) and angiotensin-converting enzyme inhibitors (ACEI). DBP declined only in PH patients treated with ACEI. SBP and DBP (both p<0.0001) declined significantly in SH patients. Post-therapy BP was similar in SH patients treated with either CCB or ACEI. Post-therapy SBP and DBP were significantly lower in SH patients than in PH patients; moreover, therapy induced a greater decline in SBP and DBP in the SH patients. Compared to PH patients, SH patients were twofold more likely to achieve a SBP less than the 95th% after therapy. We conclude that (1) significant lowering of BP with either CCB or ACEI is achievable in most children with HTN, and (2) SH patients respond better to therapy than those with PH.

Manejo de la hipertensión arterial en niños y adolescentes: recomendaciones de la Sociedad Europea de Hipertensión

“…Gran parte de la información relativa a la seguridad y la eficacia de este fármaco proviene de estudios en niños sin HTA, con enfermedad cardiaca o HTA portal 123 . La situación es similar en el caso de atenolol y metoprolol 124 .…”

Control of Hypertension in Treated Children and Its Association With Target Organ Damage

“…5 Most recently, the control of HT has been found to be even worse, 65% of children with primary or secondary HT being hypertensive despite antihypertensive therapy. 6 These studies were performed using clinic BP measurement. Ambulatory BP monitoring (ABPM) has become a valuable method in the management of HT.…”

Review: Lisinopril in paediatric medicine: a retrospective chart review of long-term treatment in children

“…Silverstein observed that the decline in SBP and DBP was significantly higher in children with secondary hypertension than with primary hypertension. 19 A prospective study by Flynn could not demonstrate this difference. 20,21 Because our study and the study by Silverstein were retrospective, comparison with the Flynn study cannot be made.…”