Antihypertensive agents: a long way to safe drug prescribing in children
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REVIEW
Antihypertensive agents: a long way to safe drug prescribing in children Nida Siddiqi 1 & Ibrahim F. Shatat 2,3,4 Received: 31 May 2019 / Revised: 12 July 2019 / Accepted: 23 July 2019 # The Author(s) 2019
Abstract Recently updated clinical guidelines have highlighted the gaps in our understanding and management of pediatric hypertension. With increased recognition and diagnosis of pediatric hypertension, the use of antihypertensive agents is also likely to increase. Drug selection to treat hypertension in the pediatric patient population remains challenging. This is primarily due to a lack of large, well-designed pediatric safety and efficacy trials, limited understanding of pharmacokinetics in children, and unknown risk of prolonged exposure to antihypertensive therapies. With newer legislation providing financial incentives for conducting clinical trials in children, along with publication of pediatric-focused guidelines, literature available for antihypertensive agents in pediatrics has increased over the last 20 years. The objective of this article is to review the literature for safety and efficacy of commonly prescribed antihypertensive agents in pediatrics. Thus far, the most data to support use in children was found for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB). Several gaps were noted in the literature, particularly for beta blockers, vasodilators, and the long-term safety profile of antihypertensive agents in children. Further clinical trials are needed to guide safe and effective prescribing in the pediatric population. Keywords Antihypertensive agents . Clinical trials . Drug therapy . Hypertension . Pediatric . Safety
Introduction Hypertension (HTN) in children and adolescents is defined as an average clinic measured systolic blood pressure (SBP) and/ or diastolic blood pressure (DBP) ≥ 95th percentile (on the basis of age, sex, and height percentiles) [1]. Historically, pediatric HTN was considered a secondary phenomenon until proven otherwise. However, recent evidence describes primary HTN as being more likely than secondary HTN among children referred to subspecialty care for evaluation of elevated blood pressure (BP). Furthermore, the prevalence of HTN in children has been rising alongside the prevalence of obesity and increased awareness and screening among pediatricians
* Ibrahim F. Shatat [email protected] 1
Department of Pharmacy, Sidra Medicine, Doha, Qatar
2
Pediatric Nephrology and Hypertension, Sidra Medicine, HB. 7A. 106A, PO Box 26999, Doha, Qatar
3
Weill Cornell College of Medicine-Qatar, Ar-Rayyan, Qatar
4
Medical University of South Carolina, Charleston, SC, USA
and general practitioners. It is estimated that 3.5% of children and adolescents suffer from HTN, with prevalence as high as 25% in obese and overweight adolescents [2, 3]. In children and adolescents diagnosed with HTN, the treatment goal with non-pharmacologic and pharmacologic therapy should be a reduction in SBP and DBP to
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