Pharmacologic treatment of hypertension in children and adolescents

Flynn, Joseph T.; Daniels, Stephen R.

doi:10.1016/j.jpeds.2006.08.074

Cited by 78 publications

(60 citation statements)

References 50 publications

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“…[119][120][121] Other drugs are prescribed in obese adolescents with MS in order to treat insulin resistance (that is, metformin), [122][123][124][125][126] hypertension or dyslipidemia (statins, antihypertensives). [127][128][129] Table 3 compared main characteristics of drug treatment along with PA. We described the changes in anthropometric, biochemical and metabolic parameters that are influenced by drug treatment and PA. Although some effects are not clear or are controversial, it appears evident that PA alone should be preferable in term of overall evaluation.…”

Section: Pa As a Drug: Its Use Effects And Limitsmentioning

confidence: 99%

Physical activity as the main therapeutic tool for metabolic syndrome in childhood

Brambilla¹,

Pozzobon

Pietrobelli

2010

Int J Obes

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Physical activity (PA) and diet directly influence obesity and metabolic syndrome (MS) as important determinants of body composition. Understanding how PA relates to MS in youth is of great importance, and could offer a common strategy for clinical and public health approaches to control this condition. The underlying disorder of MS is a condition of insulin resistance, and a strong relationship between PA level and insulin sensitivity is clearly ascertained. The type, duration, frequency and intensity of PA affect fuel metabolism, in particular carbohydrate and lipid oxidation. The possible modulation of metabolism because of increased fat oxidation by PA is the basis for both prevention and restoration of insulin resistance and MS in obese children. In daily clinical practice, diet followed by pharmacologic treatment are usually the approaches taken, whereas PA is often considered just a suggestion. Although diet and PA have different effects on body composition, with both contributing to fat loss, only PA increases muscle mass and thus has a direct effect on metabolic function, expressed by changes in cardiovascular risk factors. Therefore, it is important to remember their complementary but different targets in daily clinical practice, such as body weight control for diet and metabolic health for PA. In this review, we have summarized the literature on the relationship between PA and MS in pediatrics. Then, we have analyzed the possibility of using PA for MS treatment, as an alternative to drugs, by discussing the results of intervention studies, reasons for low compliance to PA, related benefits, adherence difficulties and costs. Finally, we have tried to suggest recommendations for a multiple-step PA strategy in children and adolescents at risk for MS, by considering PA as the 'key' player in treatment.

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Section: Pa As a Drug: Its Use Effects And Limitsmentioning

confidence: 99%

Physical activity as the main therapeutic tool for metabolic syndrome in childhood

Brambilla¹,

Pozzobon

Pietrobelli

2010

Int J Obes

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“…A meta-analysis of clinical trials in children and adolescents showed a 1% reduction in systolic blood pressure and 3% reduction in diastolic blood pressure with exercise interventions, although these findings were not statistically significant [57]. Nonetheless, increases in physical activity, both through, aerobic exercise and noncompetitive resistance training, has been recommended for the treatment and prevention of obesity, hypertension, and other cardiovascular risk factors in youth [58]. A caveat is that patients with uncontrolled stage 2 hypertension should be restricted from participation in competitive sports.…”

Section: Non-pharmacological Managementmentioning

confidence: 99%

Hypertension and Hypertensive Heart Disease in Children and Adolescents

Elshamaa¹

2018

Clin Case Rep Rev

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The epidemic of overweight and obesity in youth is increasing the prevalence of prehypertension and hypertension among children and adolescents. The younger the child is at presentation and the more severe the blood pressure abnormality, the more likely a secondary cause of hypertension to be present. Measurement of blood pressure (BP) in children requires adaptation to the age and size of the children. Interpretation must be related to normative values specific to age, gender and height. Evaluation is primarily aimed at identifying secondary causes of hypertension, associated comorbidities, additional risk factors, and evidence of target organ damage. Ambulatory blood pressure monitoring is emerging as a useful tool for evaluation of some patients, particularly for those with suspected white coat hypertension. Uncontrolled and prolonged elevation of blood pressure can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart. These changes in turn can lead to the development of left ventricular hypertrophy, coronary artery disease, various conduction system diseases, and systolic and diastolic dysfunction of the myocardium, cardiac arrhythmias (especially atrial fibrillation), and congestive heart failure. Although these diseases generally develop in response to chronically elevated BP, marked and acute elevation of BP can lead to accentuation of an underlying predisposition to any of the symptoms traditionally associated with chronic hypertension. Management of prehypertension and hypertension is directed at the underlying cause, exacerbating factors, and the magnitude of the blood pressure abnormality. Healthy behavioral changes are a primary management tool for treating hypertension, and more particularly prehypertension and for addressing other cardiovascular risk factors, such as obesity. Pharmacological management is reserved for patients with hypertension who do not respond to behavioral changes, have additional cardiovascular risk factors or diabetes, are symptomatic or have developed target organ damage.

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“…3 Besides, there is lack of suspensions or other age appropriate drug formulations. 20 In 2007, the European authorities implemented the European Regulation after realizing that children also have the right to be treated with drugs that have been studied in children. 1 The goal of this Regulation of medicinal products for pediatric use is to increase the availability of medicines authorized for children, as well as to improve the information on the use of medicinal products in the pediatric population.…”

Section: Therapeutic Orphansmentioning

confidence: 99%

Management of hypertension in children and adolescents

Bruyne¹,

Walle

2014

Acta Clinica Belgica

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Hypertension has been recognized as an important health issue in the pediatric population over the past years. This emphasizes the need for an organized and effective plan for diagnosis and management. This review provides information to guide physicians through a structured approach to (1) screen children for hypertension during routine visits; (2) use normative blood pressure tables for diagnosis and classification; (3) perform a clinical evaluation to identify the presence of risk factors, comorbidities and/or target organ damage; and (4) initiate an individualized plan of care that includes follow-up blood pressure measurement, therapeutic lifestyle changes and -if necessary -pharmacological therapies.

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Pharmacologic treatment of hypertension in children and adolescents

Cited by 78 publications

References 50 publications

Physical activity as the main therapeutic tool for metabolic syndrome in childhood

Physical activity as the main therapeutic tool for metabolic syndrome in childhood

Hypertension and Hypertensive Heart Disease in Children and Adolescents

Management of hypertension in children and adolescents

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