Effects of guanabenz in adolescent hypertension

Fourteen adolescent patients, aged 12 to 21 years, with essential hypertension were treated on an open basis with guanabenz, a centrally acting antihypertensive agent. Guanabenz doses of 3-24 mg/day (0.08-0.20 mg/kg/day) given twice daily for 2 months effectively lowered mean supine blood pressure (p less than 0.05), standing blood pressure (p less than 0.01), and supine pulse rate (p less than 0.01). Body weight and standing pulse rate were unaffected. Adverse effects were mild, usually short lived, and did not interfere with therapy. No adverse effects were noted in laboratory test results or physical examinations. Baseline funduscopic photography revealed numerous but minor changes, including altered arteriovenous ratios and crossing changes. Prestudy echocardiograms revealed changes consistent with early hypertensive changes. Poststudy echocardiograms obtained in nine of the 14 subjects after 4-6 weeks of guanabenz therapy suggested that cardiac hypertrophy had regressed, but these changes did not reach statistical significance. These preliminary results suggest that guanabenz can be a safe and effective treatment for hypertensive children, that early hypertensive changes can be seen in the fundi and echocardiograms of mildly hypertensive adolescents, and that some echocardiographic changes may be reversed even after relatively short-term guanabenz therapy.