Treatment of hypertension in children

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.