Effects of Common Antihypertensive Class Medications on BMI z-Score in Adolescents

Antihypertensive class medications are prescribed long-term for adolescents, including for conditions other than hypertension. Evidence on weight effects is limited.

To assess the weight effects of commonly prescribed antihypertensive class medications among adolescents, regardless of clinical indication for use.

This retrospective study was conducted using electronic health record (EHR) data from a multi-site US research network. The study cohort included adolescents aged 13.0-19.5 years with ≥ 1 antihypertensive class medication order during 2010-2019. Weight and height documented in the EHR were used to calculate BMI z-scores. Inverse probability weighting with marginal structural models was used to account for selection factors and covariates.

Overall, 23 853 adolescents were prescribed an antihypertensive class medication, including clonidine (prescribed to n = 7491), guanfacine (n = 6411), lisinopril (n = 3584), propranolol (n = 3015), spironolactone (n = 1926), and atenolol (n = 1426). At baseline, 13% had a hypertension diagnosis. At 12 months after medication initiation, the estimated population-level BMI z-score was significantly increased for propranolol (BMI z-score 0.19 [95% CI 0.09, 0.29]) and significantly decreased for lisinopril (-0.06 [95% CI -0.10, -0.01]); clonidine, guanfacine, spironolactone, and atenolol were not associated with a significant change in BMI z-score.

Most antihypertensive class medications were not associated with statistically significant weight gain when prescribed to adolescents.