- For pediatric hypertension, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEi/ARBs) might be the best drug choice.
- Data are lacking on other options, however, so it is not definitive.
Why this matters
- The study authors say that their findings support the use of ACEi in the clinic for pediatric hypertension that is refractory to lifestyle interventions.
- Lisinopril (Zestril), enalapril (Vasotec) both:
- Bested placebo for decreasing systolic and diastolic BP: 7.8 (95% credibility interval [CrI], 2.3-12.8) mmHg/6.6 (95% CrI, 2.5-10.5) mmHg and 7.8 (95% CrI, 2.5-13.5) mmHg/6.2 (95% CrI, 2-10.6) mmHg, respectively; and
- Bested eplerenone (Inspra) for diastolic BP reductions: 6.5 (95% CrI, 1.1-11.6) and 6.1 (95% CrI, 0.7-11.8) mmHg, respectively.
- Losartan (Cozaar) bested placebo for reducing diastolic BP: 3.7 (95% CrI, 0.3-7.5) mmHg.
- As a class, ACEi/ARBs bested placebo for systolic and diastolic BP reductions.
- Network meta-analysis of 13 randomized, placebo-controlled trial results (>50 patients, >4 weeks of follow-up); n=2378 patients, median age, 12 years.
- Endpoint: reductions in systolic and diastolic BP.
- Funding: European Union Horizon 2020 research and innovation programme.
- Few trials looked at interventions other than ACEi/ARBs.
- Some heterogeneity, small study populations in included trials.