From the FDA Drug Label
8.4 Pediatric Use Antihypertensive effects and safety of lisinopril have been established in pediatric patients aged 6 to 16 years Safety and effectiveness of lisinopril have not been established in pediatric patients under the age 6 or in pediatric patients with glomerular filtration rate < 30 mL/min/1.73 m2
2.1 Hypertension Pediatric Patients 6 years of age and older with hypertension Lisinopril tablets are not recommended in pediatric patients < 6 years or in pediatric patients with glomerular filtration rate < 30 mL/min/1.73m2
Age to not initiate antihypertensive medication:
- Under 6 years of age, as safety and effectiveness of lisinopril have not been established in pediatric patients under the age 6 1.
- Pediatric patients with glomerular filtration rate < 30 mL/min/1.73 m2, as lisinopril tablets are not recommended in these patients 1 and 1.
From the Research
There is no specific age at which antihypertensive medication should not be initiated, as the decision to start treatment should be based on individual patient factors, including blood pressure readings, cardiovascular risk, comorbidities, and potential benefits versus risks of treatment, rather than age alone. According to the most recent study 2, lifestyle changes are recommended as first-line treatment for management of high blood pressure for young adults, when 10-year atherosclerotic cardiovascular disease risk score is < 10%. If lifestyle changes alone do not control blood pressure, then providers have access to four classes of first-line blood pressure lowering agents to treat hypertension.
Some key points to consider when deciding to initiate antihypertensive medication include:
- Blood pressure readings: The decision to start treatment should be based on the patient's blood pressure readings, rather than their age.
- Cardiovascular risk: Patients with a high cardiovascular risk, such as those with diabetes or kidney disease, may benefit from earlier initiation of antihypertensive medication.
- Comorbidities: The presence of comorbidities, such as heart failure or coronary artery disease, may also influence the decision to start treatment.
- Potential benefits versus risks: The potential benefits of treatment, such as reducing the risk of cardiovascular events, should be weighed against the potential risks, such as adverse effects or interactions with other medications.
In terms of specific medications, common first-line options include:
- Thiazide diuretics (e.g., hydrochlorothiazide 12.5-25mg daily)
- ACE inhibitors (e.g., lisinopril 5-10mg daily)
- ARBs (e.g., losartan 25-50mg daily)
- Calcium channel blockers (e.g., amlodipine 2.5-5mg daily)
Treatment goals may be slightly less aggressive in the very elderly, often aiming for systolic blood pressure < 150 mmHg rather than < 130 mmHg as in younger adults. The key is to individualize treatment based on the patient's overall health status, functional capacity, life expectancy, and preferences. As noted in another study 3, the prescription rate of antihypertensive medication was lower in patients aged < 75 years with CKD stage G1-G5, compared to patients aged ≥ 75 years old with CKD stage G1-G3. However, the most recent study 2 provides the most up-to-date guidance on this topic.