Effectiveness and Safety of Valsartan in Children Aged 6 to 16 Years With Hypertension

Wells, Thomas G.; Blumer, Jeffrey L.; Meyers, Kevin; Neto, Jose P R; Meneses, Rejane de Paula; Litwin, Mieczysław; Walle, Johan Vande; Solar-Yohay, Susan; Shi, Victor; Han, Guangyang

doi:10.1111/j.1751-7176.2011.00432.x

Cited by 46 publications

(74 citation statements)

References 32 publications

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“…Other notable age-related observations in the total population included a greater prevalence of secondary hypertension among young children (<6 years) than in school-aged children (6 to <12 years) and adolescents (12 to <17 years); 83.3% versus 38.2% and 40.0%, respectively (both P<0.0001); higher mean sitting diastolic BP (DBP) index in young children than in school-aged children and adolescents (1.1 versus 1.0 and 1.0, respectively; both P<0.0001); and lower prevalence of elevated cholesterol (>95th percentile for age and sex) 10 among young children than among school-aged children or adolescents (7 …”

Section: Resultsmentioning

confidence: 99%

“…Study A2307 6 was performed at 36 centers in 7 countries, and Study A2302 7 was performed at 55 centers in 9 countries. Institutional review boards/ethics committees at each participating center reviewed and approved the study protocols; written informed consent/assent was obtained for all of the study participants according to local requirements.…”

Section: Methodsmentioning

confidence: 99%

“…6,7 Study A2307 enrolled children aged <6 years with seated systolic blood pressure (BP; SBP) ≥95th percentile for age, sex, and height 8 who were not receiving antihypertensive treatment or who had inadequately controlled hypertension on current treatment. Minimum patient weight was 8 kg.…”

Section: Subjectsmentioning

confidence: 99%

“…Key exclusion criteria included seated SBP ≥25% above the 95th percentile; clinically significant laboratory abnormalities; estimated creatinine clearance <30 mL/min per meter squared; aortic coarctation with gradient ≥30 mm Hg; bilateral renal artery stenosis; organ transplantation other than renal or heart transplantation; known sensitivity to valsartan or other angiotensin II receptor blockers; or use of any investigational drug within 30 days before study drug administration. Study A2302 7 enrolled children and adolescents aged 6 to 16 years with seated SBP ≥95th percentile for age, sex, and height 8 but <5% above the 99th percentile. Minimum patient weight was 18 kg.…”

Section: Subjectsmentioning

confidence: 99%

“…6,7 In this report we have pooled the baseline clinical and demographic data on the subjects enrolled in those trials to better describe the characteristics of such patients in the current era.…”

mentioning

confidence: 99%

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Clinical and Demographic Characteristics of Children With Hypertension

et al. 2012

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Abstract-Most information describing hypertension in the young comes from single-center reports. To better understand contemporary demographic and clinical characteristics of hypertensive children and adolescents, we examined baseline data on 351 children aged 1 to <17 years old who were enrolled in 2 multicenter trials of valsartan. Anthropometric, laboratory, and demographic information at randomization was extracted from the clinical trials databases. Summary variables were created and compared for 3 age groups: <6 years (n=90), 6 to <12 years (n=131), and 12 to <17 years (n=130). Comparisons were also made between different etiologies of hypertension and for different anthropometric categories. Children <6 years old were significantly more likely to have secondary hypertension and were significantly less likely to have weight or body mass index >95 percentile compared with older children. Estimated glomerular filtration rate was significantly lower in children <6 years old (90.9±31.8 mL/min per 1.73 m 2 ) than in the other 2 age groups (6 to <12 years, 141.4±42.1 mL/min per 1.73 m 2 ; 12 to <17 years, 138.3±46.0 mL/min per 1.73 m 2 ). Frequency of total cholesterol >95 percentile was significantly lower in children aged <6 years. Diastolic blood pressure index (subject blood pressure÷95 percentile) was significantly higher in children <6 years old (1.1 versus 1.0 in both the 6 to <12 years and 12 to <17 years groups; both P<0.0001). We conclude that hypertensive children <6 years are more likely to have secondary hypertension and to have higher diastolic blood pressure and lower glomerular filtration rate and are less likely to be obese or to have elevated cholesterol than school-aged children or adolescents. These findings emphasize unique aspects of childhood hypertension that should be considered when evaluating children and adolescents with elevated blood pressure and in designing future clinical trials.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical and Demographic Characteristics of Children With Hypertension

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Screening for Hypertension in Children and Adolescents

Gartlehner

Schaaf

Orr

et al. 2020

JAMA

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ImportanceChildhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks.ObjectiveTo update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force.Data SourcesPubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020.Study SelectionFair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions.Data Extraction and SynthesisTwo reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively.Main Outcomes and MeasuresSensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments.ResultsForty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were −4.38 mm Hg (95% CI, −7.27 to −2.16) for angiotensin-converting enzyme inhibitors and −3.07 mm Hg (95% CI, −4.99 to −1.44) for angiotensin receptor blockers. Candesartan reduced SBP by −6.56 mm Hg (P < .001; n = 240). β-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (−4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (−2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (−7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure.Conclusions and RelevanceObservational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.

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