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Primary hypertension at a single center: treatment, time to control, and extended follow-up

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Abstract

We present data on presentation, treatment, and follow-up of 65 pediatric patients with primary hypertension treated over the past 12 years, including initial anthropometric data, pharmacologic treatment, time to control for both systolic and diastolic blood pressure (SBP/DBP), and maintenance of control over time. Data was normalized to standard deviation scores (SDS) for mathematical analysis, and antihypertensive medication dosages were converted to dosage equivalents for a single member of each antihypertensive class. We used multiple regression analysis and Kaplan-Meier survival curves to determine the time to control, medication, and dose effectiveness. Patients were seen for an average of seven visits over 25 months. Initial BPs averaged 134/71 mmHg (2.1/0.6 SDS). Patients were taller, heavier, and had higher body mass index than average for age and sex. By the fourth visit, SBP was <90th percentile in 79%. Ninety percent could be controlled, although 32 lost control at some point (at least 16 due to noncompliance). At the last visit, 46 were controlled, and 5/8 patients off medication remained normotensive. Only angiotensin-converting enzyme inhibitors and β-blockers demonstrated significant association with BP control. This is the first study to document the time to control of BP, and it can serve as an initial standard for quality assessment.

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Authors and Affiliations

  1. Department of Pediatrics, The Penn State College of Medicine, The Milton S. Hershey Medical Center, PO Box 850, Hershey, PA, 17033, USA

    Amy DiPietro, Deborah Kees-Folts & Steven Joel Wassner

  2. Department of Healthcare Quality and Safety, School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA

    Susan DesHarnais

  3. Department of Public Health Sciences, the Penn State College of Medicine, Penn State University, Hershey, PA, USA

    Fabian Camacho

Authors
  1. Amy DiPietro
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  2. Deborah Kees-Folts
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  3. Susan DesHarnais
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  4. Fabian Camacho
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  5. Steven Joel Wassner
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Corresponding author

Correspondence to Steven Joel Wassner.

Appendix

Appendix

Calculation of antihypertensive dosage equivalents

Medication class

Base medication

Medication administered

× Conversion factor

Angiotensin-converting enzyme inhibitors (ACEI)

Enalapril equivalents

Enalapril

1

Lisinopril

1

Fosinopril or quinapril or benazepril

0.5

Ramipril

2

β-blockers

Propranolol

Propranolol

1

Atenolol

6.4

Metoprolol

1.42

Calcium-channel inhibitors

Amlodipine

Amlodipine

1

Nifedipine

0.055

Thiazide diuretics

Hydrochlorothiazide

Hydrochlorothiazide

1

Chlorothiazide

0.1

Angiotensin receptor blockers

Valsartan

Valsartan

1

Losartan

3.2

Olmesartan

8

  1. Example: a child received a dose of 20 mg of ramipril, which is equivalent to a dose of 40 mg of enalapril (20× conversion factor of 2 = 40)

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DiPietro, A., Kees-Folts, D., DesHarnais, S. et al. Primary hypertension at a single center: treatment, time to control, and extended follow-up. Pediatr Nephrol 24, 2421–2428 (2009). https://doi.org/10.1007/s00467-009-1297-4

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  • DOI: https://doi.org/10.1007/s00467-009-1297-4

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