High Blood Pressure in Children and Adolescents: Current Perspectives and Strategies to Improve Future Kidney and Cardiovascular Health

Robinson, Cal; Chanchlani, Rahul

doi:10.1016/j.ekir.2022.02.018

Cited by 37 publications

(37 citation statements)

References 215 publications

(331 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Non-pharmacological management consists of weight loss, regular physical activity, and reduced sodium intake. The implementation of these strategies is recommended in all children with AH [ 15 , 16 ]. Non-pharmacological treatment is frequently initiated in children with non-severe primary AH without target organ damage, while these measures are usually insufficient in those with secondary AH [ 1 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Pharmacological Treatment of Arterial Hypertension in Children and Adolescents in Lithuania

Ivanova

Ruzgienė

Ažukaitis

et al. 2022

IJERPH

View full text Add to dashboard Cite

The global prevalence of arterial hypertension (AH) in the pediatric population is increasing, but therapeutic approaches and the choice of the most suitable antihypertensive medications remains challenging. The study aimed to estimate the prevalence, treatment rates, and pharmacological treatment patterns of children and adolescents with AH in Lithuania during 2019 using real-world data. The study population consisted of citizens of Lithuania aged 0 to 17 years, who were diagnosed with AH according to the International Classification of Diseases (ICD). The analysis of reimbursed antihypertensive medication prescriptions was performed according to AH etiology and age. The overall prevalence of AH by diagnostic ICD codes in 2019 was 0.29%:0.24% for primary and 0.05% for secondary. Treatment rates were 39.8% for primary AH and 66.3% for secondary AH. Angiotensin-converting enzyme inhibitors (ACEi) were the most popular medications irrespective of the etiology of AH or age. Beta-blockers were in the second place and used more often in older children. Calcium channel blockers were the third and angiotensin receptor blockers were the fourth most frequent choices. Enalapril was the most popular agent in the ACEi group and metoprolol in the beta-blocker group. Nearly forty percent of Lithuanian children with primary AH receive pharmacological therapy compared to two-thirds with secondary AH. Although ACEi are the predominant class of antihypertensive medications, discordances with available guidelines are evident, particularly in the overuse of beta-blockers and underuse of diuretics.

show abstract

Section: Discussionmentioning

confidence: 99%

Pharmacological Treatment of Arterial Hypertension in Children and Adolescents in Lithuania

Ivanova

Ruzgienė

Ažukaitis

et al. 2022

IJERPH

View full text Add to dashboard Cite

show abstract

“…Unlike hypertension in adults that recommended the initiation of special antihypertensive agents, limited hypertension guidelines for children generally specified antihypertensive drugs initiation hierarchy. 10,25 This study demonstrated the capabilities and limitations of pooling electronic medical record data from multiple different hospitals to create "big data" for researches. However, sharing data across systems is a challenge due to the lack of data standards and inconsistencies in data collection.…”

mentioning

confidence: 88%

Real-World Prescribing Patterns for Hypertensive Children in China from 2018 to 2021: A Cross-Sectional Multicenter Study

Qi¹,

Wang²,

Kan³

et al. 2023

RMHP

View full text Add to dashboard Cite

Background: Pediatric hypertension become an early marker of cardiovascular diseases, but their antihypertensive drug use patterns are rarely known. Purpose: To investigate the epidemiological characteristics of pediatric hypertension and the use of antihypertensive drugs in the real world in China. Methods: In this study, the demographic, diagnosis, and medication prescription data including the antihypertensive drug types and comorbidities, were analyzed. The antihypertensive drugs use were evaluated according to the Chinese guidelines for hypertension. Results: 1301 prescriptions (number of visits) containing 1880 antihypertensive medical orders were collected. The average number of antihypertensive drugs per prescription was 1.45 (±0.75). The patients aged 16 to 18 (70.18%) accounted for the highest proportion. Kidney diseases (33.28%) were the most common comorbidities. Calcium channel blocker (CCB), angiotensin II receptor blocker (ARB), and β receptor blocker (BB) were the most used antihypertensive drugs. The most frequent monotherapy was CCB, while that of two and three drugs combination were ARB+CCB and ARB+BB+CCB, respectively. Metoprolol (11.44%), nifedipine (10.64%), amlodipine (10.59%), valsartan (6.12%) were the most commonly used antihypertensive drugs. The utilization rate of fixed compound preparations was 7.34%. However, the percentage of recommended antihypertensive drugs was just 14.20%, while the recommended drug combination was 84.93% according to the guidelines. Conclusion:For the first time ever we reported the antihypertensive prescription analysis in children in a large area of China. Our data provided new insights into the epidemiological characteristics and drug use in hypertensive children. We found that the guidelines for medication management in hypertensive children were not routinely followed. The wide use of antihypertensive drugs in children and those with weak clinical evidence raised concerns regarding its rational use. The findings could lead to more effective management of hypertension in children.

show abstract

“…In a large single-center study including 1025 hypertensive children, kidney diseases present two-thirds of total cases [ 5 ]. In children with CKD, hypertension is common with a range from 48% to 70% [ 6 ]. Of note is that more than 90% of hypertensive children are not receiving treatment [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Of note is that more than 90% of hypertensive children are not receiving treatment [ 7 ]. Importantly, even if hypertensive children with CKD receive anti-hypertensive medication, up to 74% of them are still uncontrolled [ 6 ], not to mention that uncontrolled hypertension is a major risk factor for progression to end stage kidney disease (ESKD). Although increased CV events and accelerated atherosclerosis have been extensively documented in patients with ESKD, increasing evidence highlights the increased risk for CV events that prevails in early stages of CKD.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Risks of Hypertension: Lessons from Children with Chronic Kidney Disease

Tain

Hsu²

2022

Children

View full text Add to dashboard Cite

Hypertension is the most common complication of chronic kidney disease (CKD) in children, having a strong association with subsequential cardiovascular disease (CVD). In pediatric CKD, a considerable percentage of children with hypertension are undiagnosed or undertreated. Prior research has evaluated structural and functional markers of subclinical CVD and biomarkers in adults with CKD, while ideal biomarkers in pediatrics are still insufficiently studied. The ultimate goal of this review is to summarize what is currently known about state of hypertension, cardiovascular risk factors, and potential CVD markers/biomarkers in children with pre-dialysis CKD. We discuss omics-related biomarkers and the pathophysiologic processes of endothelial dysfunction, kidney injury, oxidative stress and inflammation that are classified by specific biomarkers. Moreover, we illustrate the existing challenges and highlight the paucity of pediatric CKD research to evaluate these CVD biomarkers for future clinical pediatric practice. Thus, achieving clinical utility of CVD biomarkers for use in pediatric CKD remains a significant challenge requiring additional efforts.

show abstract

High Blood Pressure in Children and Adolescents: Current Perspectives and Strategies to Improve Future Kidney and Cardiovascular Health

Cited by 37 publications

References 215 publications

Pharmacological Treatment of Arterial Hypertension in Children and Adolescents in Lithuania

Pharmacological Treatment of Arterial Hypertension in Children and Adolescents in Lithuania

Real-World Prescribing Patterns for Hypertensive Children in China from 2018 to 2021: A Cross-Sectional Multicenter Study

Cardiovascular Risks of Hypertension: Lessons from Children with Chronic Kidney Disease

Contact Info

Product

Resources

About