From the Guidelines
The best medicine for juvenile hypertension typically starts with lifestyle modifications, followed by medication if needed, with ACE inhibitors like lisinopril (0.1-0.6 mg/kg/day) or angiotensin receptor blockers such as losartan (0.7-1.4 mg/kg/day) being usually first-line medications due to their effectiveness and favorable side effect profiles. According to the evidence provided by 1, the initial dose of lisinopril is 0.2 mg/kg per day up to 10 mg/day, and the maximal dose is 0.6 mg/kg per day up to 40 mg/day. The choice of medication depends on the child's specific situation, including any underlying conditions like kidney disease or diabetes. These medications work by either relaxing blood vessels, reducing fluid volume, or decreasing the heart's workload. It's essential to note that medication should complement, not replace, lifestyle changes such as maintaining a healthy weight, regular physical activity, limiting sodium intake, and avoiding tobacco and alcohol. Treatment decisions should always be made under the guidance of a pediatric specialist who can tailor the approach to the individual child's needs. Some key points to consider when treating juvenile hypertension include:
- Lifestyle modifications are the first line of treatment
- Medication is added if lifestyle modifications are not effective
- ACE inhibitors and angiotensin receptor blockers are commonly used medications
- Calcium channel blockers like amlodipine are also commonly used
- Treatment should be initiated at the lowest dose and gradually increased until blood pressure is controlled
- Regular monitoring for side effects is necessary
- The choice of medication depends on the child's specific situation, including any underlying conditions. As stated in 1, many medications have been approved by the U.S. Food and Drug Administration for the treatment of hypertension in children, including diuretics, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, β-blockers, and vasodilators. However, the evidence from 1 and 1 suggests that there are several critical evidence gaps in better understanding the potential net benefit of screening for hypertension in childhood and adolescence. Additionally, the evidence from 1 and 1 highlights the importance of optimal blood pressure measurement techniques and the need for routine screening of blood pressure at well-child visits starting at age 3 years. Overall, the treatment of juvenile hypertension requires a comprehensive approach that includes lifestyle modifications, medication, and regular monitoring, with the goal of controlling blood pressure and reducing the risk of long-term complications.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Juvenile Hypertension
The treatment of juvenile hypertension typically involves a combination of lifestyle changes and medication. According to 2, first-line treatment of stage I hypertension with target organ damage and stage II hypertension includes both lifestyle changes and medications.
Medication Options
Some of the medication options for juvenile hypertension include:
- Angiotensin-converting enzyme (ACE) inhibitors
- Thiazide diuretics
- Calcium-channel blockers These medications are often used as first-line agents for the treatment of hypertension in children 2, 3.
Lifestyle Changes
Lifestyle changes, such as adhering to the Dietary Approaches to Stop Hypertension diet, are also an important part of treating juvenile hypertension 3. Regular physical activity and maintaining a healthy weight can also help to reduce blood pressure.
Combination Therapy
In some cases, combination therapy may be necessary to achieve adequate blood pressure control. According to 4, fixed very-low-dose combinations containing an ACE inhibitor or an AT1 receptor blocker and a diuretic may be effective for the treatment of hypertension.
Calcium Channel Blockers
Calcium channel blockers, such as lercanidipine, may also be used to treat hypertension in children 5. These medications can be effective in lowering blood pressure and reducing cardiovascular risk.
ACE Inhibitors
ACE inhibitors are commonly used to treat hypertension in children and have been shown to be effective in reducing blood pressure and slowing the progression of cardiovascular disease 6. However, they may have side effects such as cough and angioedema, and may not be suitable for all patients.