From the Guidelines
Treatment for hypertension in infants typically begins with identifying and addressing the underlying cause, and initial management includes careful monitoring, treating the primary condition when possible, and implementing lifestyle modifications. When pharmacological treatment is necessary, first-line medications include ACE inhibitors, calcium channel blockers, or beta-blockers, with dosing carefully calculated based on the infant's weight and initiated at the lowest effective dose with gradual titration while monitoring blood pressure and watching for side effects 1. Key considerations in managing infant hypertension include:
- Identifying and addressing the underlying cause of hypertension
- Implementing lifestyle modifications such as maintaining a healthy weight and reducing sodium intake
- Using pharmacological treatment when necessary, with careful monitoring and dose adjustment
- Regular follow-up to assess medication effectiveness and adjust dosing as the infant grows
- Treatment decisions should be made by pediatric specialists experienced in managing infant hypertension, considering potential adverse effects specific to this age group, including electrolyte imbalances, growth impacts, and renal function changes 1. It is essential to prioritize the infant's health and well-being, and treatment should focus on minimizing morbidity, mortality, and improving quality of life 1.
From the FDA Drug Label
Infants with histories of in utero exposure to ACE inhibitors should be closely observed for hypotension, oliguria, and hyperkalemia. If oliguria occurs, attention should be directed toward support of blood pressure and renal perfusion. The treatment for hypertension in infants is not directly stated in the provided drug labels. However, it can be inferred that support of blood pressure and renal perfusion may be necessary in cases where infants have been exposed to ACE inhibitors in utero and are experiencing hypotension or oliguria.
- Key considerations for infants with in utero exposure to ACE inhibitors include:
- Close observation for hypotension, oliguria, and hyperkalemia
- Support of blood pressure and renal perfusion if necessary
- Possible need for exchange transfusion or dialysis in severe cases 2
From the Research
Treatment for Hypertension in Infants
The treatment for hypertension in infants involves a combination of lifestyle changes and medications.
- For stage I hypertension without target organ damage, lifestyle changes such as diet and exercise are recommended as the first line of treatment 3.
- If lifestyle changes are not effective, or if the infant has stage I hypertension with target organ damage or stage II hypertension, medications are added to the treatment plan 3.
- First-line medications for hypertension in infants include angiotensin-converting enzyme (ACE) inhibitors, thiazide diuretics, and calcium-channel blockers 3.
- In cases of severe hypertension, intravenous short-acting medications are preferred for a controlled reduction of blood pressure 4.
- The choice of medication depends on the underlying cause of hypertension and the potential side effects of the medication 3.
Medication Options
Several studies have investigated the use of different medications for hypertension in infants and children.
- ACE inhibitors, such as lisinopril and enalapril, have been shown to be effective in reducing blood pressure in children with hypertension 5, 6.
- Angiotensin receptor blockers (ARBs) have also been found to be effective in reducing blood pressure in children with hypertension 5.
- Other medications, such as diuretics and calcium-channel blockers, may also be used to treat hypertension in infants and children 3, 7.
Important Considerations
When treating hypertension in infants, it is essential to consider the potential side effects of medications and to monitor blood pressure closely.