Pediatric Drugs

, Volume 18, Issue 1, pp 31–43 | Cite as

Pharmacologic Management of Pediatric Hypertension

  • Jason MisuracEmail author
  • Kristen R. Nichols
  • Amy C. Wilson
Review Article


Hypertension in children is common, and the prevalence of primary hypertension is increasing with the obesity epidemic and changing dietary choices. Careful measurement of blood pressure is important to correctly diagnose hypertension, as many factors can lead to inaccurate blood pressure measurement. Hypertension is diagnosed based on comparison of age-, sex-, and height-based norms with the average systolic and diastolic blood pressures on three separate occasions. In the absence of hypertensive target organ damage (TOD), stage I hypertension is managed first by diet and exercise, with the addition of drug therapy if this fails. First-line treatment of stage I hypertension with TOD and stage II hypertension includes both lifestyle changes and medications. First-line agents include angiotensin-converting enzyme (ACE) inhibitors, thiazide diuretics, and calcium-channel blockers. Hypertensive emergency with end-organ effects requires immediate modest blood pressure reduction to alleviate symptoms. This is usually accomplished with IV medications. Long-term reduction in blood pressure to normal levels is accomplished gradually. Specific medication choice for outpatient hypertension management is determined by the underlying cause of hypertension and the comparative adverse effect profiles, along with practical considerations such as cost and frequency of administration. Antihypertensive medication is initiated at a starting dose and can be gradually increased to effect. If ineffective at the recommended maximum dose, an additional medication with a complementary mechanism of action can be added.


Chronic Kidney Disease Aliskiren Ambulatory Blood Pressure Monitoring Minoxidil Isradipine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards


No sources of funding were used to support the writing of this manuscript.

Conflict of interest

J. Misurac, K.R. Nichols and A.C. Wilson declare no conflicts of interest.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Jason Misurac
    • 1
    Email author
  • Kristen R. Nichols
    • 2
    • 3
  • Amy C. Wilson
    • 1
  1. 1.Department of Pediatrics, Section of Pediatric NephrologyIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of Pharmacy PracticeCollege of Pharmacy and Health Sciences, Butler UniversityIndianapolisUSA
  3. 3.Department of PharmacyRiley Hospital for Children, Indiana University HealthIndianapolisUSA

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