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Published on: May 26, 2022
A randomized prospective crossover trial of amlodipine in pediatric hypertension
J W Rogan1, D A Lyszkiewicz, D Blowey
1The Department of Pediatrics and Research Institute, The Hospital for Sick Children, Toronto, Canada.
Insights
Amlodipine is as effective as other calcium channel blockers for treating hypertension in children. Its liquid form and once-daily dosing may improve medication adherence in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Pharmacology
- Clinical Hypertension
Background:
- Pediatric hypertension requires effective and manageable treatment options.
- Amlodipine offers potential advantages for pediatric use, including liquid formulation and once-daily dosing.
- Standard long-acting calcium channel blockers like felodipine and nifedipine are commonly used.
Purpose of the Study:
- To compare the efficacy and patient compliance of amlodipine versus standard long-acting calcium channel blockers (felodipine or nifedipine) in hypertensive children.
- To evaluate blood pressure control and adherence in pediatric patients receiving amlodipine or other calcium channel blockers.
Main Methods:
- A randomized, prospective, crossover study involving 11 hypertensive children (aged 9-17 years).
- Electronic monitoring was used to assess patient compliance during 30-day treatment periods for each drug.
- 24-hour ambulatory blood pressure monitoring assessed systolic (SBP) and diastolic (DBP) blood pressures during day and night.
Main Results:
- No significant differences in mean systolic and diastolic blood pressure were observed between amlodipine and nifedipine/felodipine.
- 24-hour blood pressure monitoring showed no significant differences in daytime or nighttime SBP and DBP between treatments.
- Patient compliance rates were similar for amlodipine and the other calcium channel blockers.
Conclusions:
- Amlodipine demonstrates comparable efficacy to nifedipine and felodipine in managing hypertension in pediatric nephrology patients.
- Amlodipine's liquid formulation and once-daily administration make it a potentially optimal choice for treating young children.
- The study supports amlodipine as an effective and well-tolerated option for pediatric hypertension management.
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.
Related Concept Videos
Crossover Experiments
Crossover designs are performed even with smaller sample sizes since the samples can act as their controls. These are better than simple randomized trials since patients are exposed to all the treatments.
Antihypertensive Drugs: Angiotensin II Receptor Blockers
Antihypertensive Drugs: Direct Renin Inhibitors
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
Pharmacokinetics in Pediatric Patients: Drug Distribution
Pharmacokinetics in Pediatric Patients: Drug Excretion