Abstract
This review summarizes the current approach to antihypertensive therapy in children. It focuses on newer drugs, taking into account changes in clinical practice that have occurred since publication of the second Task Force report. Non-pharmacological therapy, including weight reduction, exercise, and dietary intervention, has great potential for the effective reduction of blood pressure. It should be introduced not only in patients with “significant” hypertension, but also in the care of patients with high normal blood pressure and to complement drug therapy for patients with “severe” hypertension. The goal of antihypertensive drug therapy is reduction of blood pressure to a level below the 95th percentile for age and sex. Attempts to rapidly achieve normal blood pressure immediately after starting therapy are contraindicated. The objective of emergency treatment is prevention of hypertension-related adverse events, and this usually requires only a modest reduction in blood pressure. Nifedipine has become the most commonly used drug for emergency treatment of asymptomatic children. Exceptionally severe elevations of blood pressure or the presence of symptoms should be treated with more potent intravenous drugs. The converting enzyme inhibitors and calcium channel blockers currently are the primary agents for chronic treatment of hypertension in children. Diuretics are usually reserved for hypertensive patients with renal disease. β-Adrenergic blocking drugs also are effective but have a number of potential adverse effects. Prazosin generally is used as a second-line agent, if the above-noted drugs are ineffective. Although minoxidil is still one of the most effective antihypertensive agents, its associated adverse effects have limited its usefulness.
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References
Task Force on Blood Pressure Control in Children (1987) Report of the Second Task Force on Blood Pressure Control in Children-1987. Pediatrics 79: 1–25
Sinaiko AR (1992) Antihypertensive agents. In: Yaffe SJ, Aranda JV (eds) Pediatric pharmacology, 2nd edn. Saunders, Philadelphia, pp 425–436
The National High Blood Pressure Education Program Working Group (1993) National High Blood Pressure Education Program Working Group Report on Primary Prevention of Hypertension. Arch Intern Med 153: 186–208
Dyer AR, Elliot P (1989) The INTERSALT study: relations of body mass index to blood pressure. J Hum Hypertens 3: 299–308
Rocchini AP, Katch V, Anderson J, Hinderliter J, Becque D, Martin M, Marks C (1988) Blood pressure in obese adolescents: effect of weight loss. Pediatrics 82: 16–23
Messerli FH, Sundgaard-Riese K, Riesen E, Dreslinski G, Dunn FG, Frohlich E, Disparat E (1983) Cardiovascular effects of obesity in arterial hypertension. Am J Med 73: 808–812
Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH (1992) Long-term morbidity and mortality of overweight adolescents. N Engl J Med 327: 1350–1355
Rocchini AP, Key J, Bondie D, Chico R, Moorehead C, Katch V, Martin M (1989) The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents. N Engl J Med 321: 580–585
Fagard RH (1993) Physical fitness and blood pressure. J Hypertens 11 [Suppl 5]: S47-S52
Hansen HS, Froberg K, Hyldebrandt N, Nielsen JR (1991) A controlled study of eight months of physical training and reduction of blood pressure in children: the Odense School-Child Study. BMJ 303: 682–685
Christiansen JL, Strong WB (1992) Blood pressure in young athletes. In: Loggie JM (ed) Pediatric and adolescent hypertension. Blackwell, Boston, pp 323–332
INTERSALT Cooperative Research Group (1988) INTERSALT: an international study of electrolyte excretion and blood pressure. Results for 24-hour urinary sodium and potassium excretion. BMJ 297: 319–328
Law MR, Frost CD, Wald NJ (1991) By how much does dietary salt reduction lower blood pressure. III. Analysis of data from trials of salt reduction. BMJ 303: 819–824
Cutler JA, Follmann D, Elliott P, Suh I (1991) An overview of randomized trials of sodium reduction and blood presure. Hypertension 17 [Suppl I]: 127–133
Sinaiko AR, Gomez-Marin O, Prineas RJ (1993) Effect of low sodium diet or potassium supplementation on adolescent blood pressure. Hypertension 21: 989–994
Tobian L (1988) Potassium and sodium in hypertension. J Hypertens 6 [Suppl 4]: S12-S24
Cappuccio FP, MacGregor GA (1991) Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens 9: 465–473
Cappuccio FP, Siani A, Strazzullo P (1989) Oral calcium supplementation in blood pressure: an overview of randomized controlled trials. J Hypertens 7: 941–946
Cutler JA, Brittain E (1990) Calcium and blood pressure: an epidemiologic perspective. Am J Hypertens 3: 137S-146S
Deal JE, Barratt TM, Dillon MJ (1992) Management of hypertensive emergencies. Arch Dis Child 67: 1089–1092
VanHarten J, Danhof M, Burggraaf K, VanBrummelen P, Breimer DD (1987) Negligible sublingual absorption of nifedipine. Lancet II: 1363–1364
Linakis JG, Lacouture PG, Woolf A (1991) Monitoring cyanide and thiocyanate concentrations during infusion of sodium nitroprusside in children. Pediatr Cardiol 12: 214–218
Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (1993) The Fifth Report of the Joint National Committee on Detection. Evaluation and Treatment of High Blood Pressure. Arch Intern Med 153: 154–183
Doyle AE (1992) Angiotension-converting enzyme (ACE) inhibition: benefits beyond blood pressure control. Am J Med 92: 1S-107S
Gansevoort RT, deZeeuw D, deJong PE (1993) Disassociation between the course of the hemodynamic and antiproteinuric effects of angiotensin I converting enzyme inhibition. Kidney Int 44: 579–584
Kamper AL, Strandgaard S, Leyssac PP (1992) Effect of enalapril on the progression of chronic renal failure: a randomized control trial. Am J Hypertens 5: 423–430
Louis EJ, Hunsicker LG, Bain RP, Rohde RD (1993) The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 329: 1456–1462
Gavras I (1992) Bradykinin-mediated effects of ACE inhibition. Kidney Int 42: 1020–1029
Sinaiko AR, Mirkin BL, Hendrick DA, Green TP, O'Dea RF (1983) Antihypertensive effect and elimination kinetics of captopril in hypertensive children with renal disease. J Pediatr 103: 799–805
O'Dea RF, Mirkin BL, Alward CT, Sinaiko AR (1988) Treatment of neonatal hypertension with captopril. J Pediatr 113: 403–406
Parish RC, Miller LJ (1992) Adverse effects of angiotensin-converting enzyme (ACE) inhibitors. Drug Safety 7: 14–31
Hricik DE, Dunn MJ (1990) Angiotensin-converting enzyme inhibitor-induced renal failure: causes, consequences, and diagnostic uses. J Am Soc Nephrol 1: 845–858
Pryde PG, Sedman AB, Nugent CE, Barr M (1993) Angiotensinconverting enzyme inhibitor fetopathy. J Am Soc Nephrol 3: 1575–1582
Sing BN (1986) The mechanism of action of calcium antagonists relative to their clinical applications. Br J Clin Pharmacol 21: 109S-121S
Zanchetti A (ed) (1993) The lipophilic dihydropyridines: a global approach to the treatment of hypertension. J Hypertens 11 [Suppl 6]: S1–S41
Luke RG (1991) Pathophysiology in treatment of post-transplant hypertension. J Am Soc Nephrol 2: S37-S44
McInnes GT, Yeo WW, Ramsay LE, Moser M (1992) Cardiotoxicity in diuretics: much speculation-little substance. J Hypertens 10: 317–335
Sinaiko AR (1992) Drugs affecting the adrenergic nervous system. In: Loggie JMH (ed) Pediatric and adolescent hypertension. Blackwell, Boston, pp 138–149
Luther RR (1989) New perspectives on selective alpha-I blockade. Am J Hypertens 2: 729–735
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Sinaiko, A.R. Treatment of hypertension in children. Pediatr Nephrol 8, 603–609 (1994). https://doi.org/10.1007/BF00858144
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DOI: https://doi.org/10.1007/BF00858144