Pharmacological management of hypertension in paediatric patients. A comprehensive review of the efficacy, safety and dosage guidelines of the available agents.

The prevalence of hypertension in children, although lower than in adults, is still significant. An underlying cause is often identified in the younger patient, with essential hypertension accounting for the majority of cases in adolescents. The natural history of hypertension in childhood is still not well delineated. Previous Task Force recommendations are addressed to reflect current experience with the newer classes of agents, namely the angiotensin converting enzyme (ACE) inhibitors and the calcium channel blockers (CCBs) where either limited or no experience was previously available. In addition, the current treatment recommendations of Joint National Committee V (JNCV) are reflected in our discussion. The current drug classes are reviewed with respect to dosage guidelines, adverse effects and potential drug-drug interactions. The advantages and disadvantages of a tailored or individualised therapeutic approach as opposed to rigid stepped care therapy will be presented. Clearly, more long term data need to be obtained with respect to the safety and efficacy of the newer classes of drugs.