Pharmacotherapy review of chronic pediatric hypertension

The number of antihypertensive agents on the market has increased dramatically over the past 20 years. Many of these agents are used to treat children and adolescents with hypertension despite there being relatively limited data available supporting such use. Recent legislation has helped to increase the number of studies conducted in children, but many clinical questions remain unanswered.

The goals of this article were to review the currently available antihypertensive agents used in the treatment of pediatric hypertension and to assist clinicians in selecting the most appropriate treatment.

Searches of MEDLINE and International Pharmaceutical Abstracts through July 2011 were conducted. Search terms used included child, pediatric, hypertension, and the following drugs: captopril, enalapril, lisinopril, fosinopril, losartan, valsartan, irbesartan, candesartan, olmesartan, amlodipine, nifedipine, isradipine, felodipine, propranolol, metoprolol, labetalol, minoxidil, furosemide, spironolactone, chlorothiazide, hydrochlorothiazide, hydralazine, and prazosin. Clinical trial data were reviewed and evaluated and were limited to English-language articles.

A total of 45 observational and randomized controlled trials were identified and summarized in this review. The angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel antagonists (CCAs) had the strongest data to support their use in pediatric patients. ACE inhibitors and ARBs are preferred agents for children with renal disease and have a favorable safety profile. Many trials, including 2 comparative trials, supported the use of CCAs, particularly amlodipine, in children.

Trials in all 3 classes suggested their efficacy as well as a tolerable adverse-effect profile. More trials in children are needed, particularly with newer antihypertensive agents. Comparative trials of different agents are the most lacking.