Pharmacological interventions for hypertension in children

Area of Science:

• Pediatric Nephrology
• Cardiovascular Pharmacology
• Evidence-Based Medicine

Background:

• Pediatric hypertension prevalence is increasing, linked to rising obesity rates.
• Children with hypertension face risks of end-organ damage and adult hypertension.
• Pharmacological treatment is often necessary, yet evidence for its use in children is limited.

Purpose of the Study:

• To systematically review the effects of antihypertensive medications in children.
• To determine dose-related effects of various antihypertensive drug classes.
• To compare monotherapy and combination therapy against placebo or other medications.

Main Methods:

• Searched multiple databases including Cochrane, MEDLINE, and EMBASE up to October 2013.
• Included randomized controlled trials (RCTs) of at least two weeks duration in hypertensive children.
• Defined hypertension as average blood pressure at or above the 95th percentile for age, height, and gender.

Main Results:

• 21 RCTs involving 3454 children were analyzed; follow-up ranged from 3 to 24 weeks.
• Candesartan demonstrated low-quality evidence of modest systolic and diastolic blood pressure reduction.
• No consistent dose-response relationship was observed for most drug classes; adverse events were generally minor.

Conclusions:

• Sparse data exist for antihypertensive agents in children, with limited outcome reporting beyond blood pressure.
• Candesartan shows some evidence of efficacy, but more research is needed.
• Current evidence suggests antihypertensive agents are safe in children for short-term use.