From the Guidelines
The first-line treatment for pediatric patients with hypertension should be lifestyle modification, not medication, according to the most recent and highest quality evidence. This approach includes weight reduction in children who are overweight or obese, increased physical activity, restricted sodium intake, as well as education and counseling 1.
Key Components of Lifestyle Modification
- Weight reduction for overweight or obese children
- Increased physical activity
- Restricted sodium intake
- Education and counseling
Pharmacologic Interventions
Medications are not recommended as first-line therapy for stage 1 hypertension in children, but may be considered for stage 2 hypertension or for hypertension that is unresponsive to lifestyle modification 1.
Medication Options
When medications are necessary, several classes are approved for use in children, including diuretics, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, β-blockers, and vasodilators 1.
Important Considerations
It's crucial to monitor the child's response to lifestyle modifications and adjust the treatment plan as needed, considering the potential need for pharmacologic interventions if lifestyle changes are insufficient to control hypertension.
From the FDA Drug Label
Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. In a clinical study involving 115 hypertensive pediatric patients 6 to 16 years of age, patients who weighed < 50 kg received either 0.625 mg, 2.5 mg or 20 mg of lisinopril once daily and patients who weighed > 50 kg received either 1.25 mg, 5 mg, or 40 mg of lisinopril once daily. At the end of 2 weeks, lisinopril lowered trough blood pressure in a dose-dependent manner with antihypertensive efficacy demonstrated at doses > 1.25 mg (0.02 mg per kg).
The first-line treatment for pediatric patients with hypertension is not explicitly stated in the provided drug labels. However, based on the available information, lisinopril can be considered as a treatment option for pediatric patients with hypertension, with a dose-dependent antihypertensive effect demonstrated in clinical studies 2 2.
- The dose of lisinopril for pediatric patients depends on their weight, with patients weighing < 50 kg receiving 0.625 mg, 2.5 mg, or 20 mg once daily, and patients weighing > 50 kg receiving 1.25 mg, 5 mg, or 40 mg once daily.
- It is essential to consult published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC), for specific advice on goals and management of hypertension in pediatric patients.
From the Research
First-Line Treatment for Pediatric Patients with Hypertension
- The first-line treatment for pediatric patients with hypertension is lifestyle modifications, including weight management, dietary modifications, and daily physical activity 3.
- These lifestyle modifications can be as effective as pharmacological interventions at lowering blood pressure, but compliance with these individual recommendations is not consistent and has led to unsatisfactory results 3.
- If lifestyle modifications are not effective, pharmacological treatment may be indicated, with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers being potential first-line options 4.
Pharmacological Treatment Options
- A network meta-analysis found that lisinopril and enalapril were superior to placebo in reducing systolic and diastolic blood pressure in pediatric patients with hypertension 4.
- Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were associated with a greater reduction in blood pressure compared to placebo, and may represent the best choice as antihypertensive treatment for pediatric hypertension 4.
- However, the use of ACE inhibitors is associated with a higher risk of adverse events, such as cough and angioedema, compared to angiotensin receptor blockers 5.
Importance of Early Treatment
- Pediatric patients with hypertension are at risk of developing target organ injury, such as left ventricular hypertrophy and vascular stiffening, and are likely to become hypertensive adults 6.
- Early recognition and treatment of hypertension in pediatric patients is crucial to prevent long-term cardiovascular complications 6.