Antihypertensive agents: Mechanisms of action, safety profiles, and current uses in children

Background: Hypertension is uncommon in children, and relatively few children receive antihypertensive medications. Objective: This article reviews the individual classes of antihypertensive medications as they are used in children, highlighting their proposed mechanisms of action, common adverse effects, and, when available, a summary of the published pediatric data. Methods: Selected publications regarding the use and pharmacokinetics of antihypertensive agents in children were identified through a literature search using PubMed(R) (1970-1999). Results: The amount of information regarding the effectiveness, safety, and adverse-effect profiles of antihypertensive agents in children is limited by the small number of patients involved and scientific study design. Conclusions: Hypertension in children is uncommon when compared with its incidence in adults, but it frequently portends an underlying disease process and can be difficult to treat. Few antihypertensive agents have been tested in children, and treatment guidelines are often based on previous experience in a small number of patients. Safe and effective use of antihypertensive agents requires adequate knowledge of their pharmacologic properties, including metabolism, disposition, and effects in children of varying ages.