Pediatric use of antihypertensive medications: Much more to learn

Background: Relatively few children require treatment for hypertension; tho se who do usually have underlying renal or other organ system disease. Howe ver, the awareness of childhood hypertension has been increasing, leading t o a greater need for sound pediatric data on which to base treatment decisi ons. Objective: This article reviews the currently available pediatric data on t he use of angiotensin-converting enzyme inhibitors, beta-adrenergic antagon ists, calcium channel blockers, and other classes of antihypertensive medic ations in children, highlighting the areas in which better data are needed. Methods: Selected publications on the therapy of childhood hypertension wer e reviewed. Emphasis was placed on studies involving newer agents and on mu lticenter, controlled trials. Results: The amount of data available regarding the efficacy and tolerabili ty of antihypertensive agents in children is limited but growing. Recent mu lticenter trials spurred by the 1997 US Food and Drug Administration Modern ization Act frequently lack important pharmacokinetic data specific to the pediatric use of these drugs. Conclusions: Well-designed pediatric trials are needed not only to demonstr ate drug efficacy in children, but also to elucidate drug kinetics and meti culously document whether the adverse effects that occur in children are di fferent from those that occur in adults.