TREATMENT OF HYPERTENSION IN CHILDREN

This review summarizes the current approach to antihypertensive therap y in children. It focuses on newer drugs, taking into account changes in clinical practice that have occurred since publication of the secon d Task Force report. Non-pharmacological therapy, including weight red uction, exercise, and dietary intervention, has great potential for th e effective reduction of blood pressure. It should be introduced not o nly in patients with ''significant'' hypertension, but also in the car e of patients with high normal blood pressure and to complement drug t herapy for patients with ''severe'' hypertension. The goal of antihype rtensive drug therapy is reduction of blood pressure to a level below the 95th percentile for age and sex. Attempts to rapidly achieve norma l blood pressure immediately after starting therapy are contraindicate d. The objective of emergency treatment is prevention of hypertension- related adverse events, and this usually requires only a modest reduct ion in blood pressure. Nifedipine has become the most commonly used dr ug for emergency treatment of asymptomatic children. Exceptionally sev ere elevations of blood pressure or the presence of symptoms should be treated with more potent intravenous drugs. The converting enzyme inh ibitors and calcium channel blockers currently are the primary agents for chronic treatment of hypertension in children. Diuretics are usual ly reserved for hypertensive patients with renal disease. beta-Adrener gic blocking drugs also are effective but have a number of potential a dverse 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.