Background: Hypertension is a major risk factor for stroke, coronary artery disease and kidney damage in adults. There is a paucity of data on the long‐term sequelae of persistent hypertension in children, but it is known that children with hypertension have evidence of end‐organ damage and are at risk of hypertension into adulthood. The prevalence of hypertension in children is increasing, most likely owing to a concurrent rise in obesity. In children with hypertension, nonpharmacological measures are often recommended as first‐line therapy, but a significant proportion of children will eventually require pharmacological treatment to reduce blood pressure, especially those with evidence of end‐organ damage at presentation or during follow‐up. A systematic review of the effects of antihypertensive agents in children has not previously been conducted.
Objectives: To determine the dose‐related effects of different classes of antihypertensive medications, as monotherapy compared with placebo; as combination therapy compared with placebo or as a single medication; or in comparisons of various doses within the same class on systolic or diastolic blood pressure (or both) in children with hypertension.
Search methods: We searched the Cochrane Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), Ovid MEDLINE (1946 to October 2013), Ovid EMBASE (1974 to October 2013) and bibliographic citations.
Selection criteria: The selection criteria were deliberately broad as there are only few clinical trials in children. We included randomized controlled trials of at least 2 weeks duration comparing antihypertensive agents either as monotherapy or as combination therapy with either placebo or another medication, or comparing different doses of the same medication, in children with hypertension. Hypertension was defined as an average (over a minimum of three readings) systolic or diastolic blood pressure (or both) on the 95th percentile or above for age, height and gender.
Data collection and analysis: Two authors independently selected relevant studies, extracted data and assessed risk of bias. We summarized data, where possible, using a random‐effects model. Formal assessment of heterogeneity was not possible because of insufficient data.
Main results: A total of 21 trials evaluated antihypertensive medications of various drug classes in 3454 hypertensive children with periods of follow‐up ranging from 3 to 24 weeks. There were five randomized controlled trials comparing an antihypertensive drug directly with placebo, 12 dose‐finding trials, two trials comparing calcium channel blockers with angiotensin receptor blockers, one trial comparing a centrally acting α‐blocker with a diuretic and one trial comparing an angiotensin‐converting enzyme inhibitor with an angiotensin receptor blocker. No randomized trial was identified that evaluated the effectiveness of antihypertensive medications on target end‐organ damage. The trials were of variable quality and most were funded by pharmaceutical companies.