Pediatric hypertension: ACEi/ARBs look like the best choice

  • Burrello J & al.
  • Hypertension
  • 1 Aug 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • Few trials looked at interventions other than ACEi/ARBs.
  • Some heterogeneity, small study populations in included trials.

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