The choice of antihypertensive drugs in the treatment of arterial hypertension in children and adolescents: retrospective study

Cover Page

Cite item

Abstract

Aim. To conduct a study of prescribed antihypertensive therapy in order to determine the criteria for choosing antihypertensive drugs and assess their effectiveness in children with arterial hypertension (AH).

Materials and methods. A retrospective study was carried out. We have analyzed medical records of 102 children with AH aged 6 to 17 years, who were examined and treated at the Smolensk Regional Children's Clinical Hospital in the period from 01.01.2019 to 31.12.2019.

Results. Based on the inclusion criteria, 102 children were selected for the retrospective study, of which 74 (72.6%) were boys and 28 (27.4%) – girls. In 56 (54.9%) patients heredity was burdened by cardiovascular diseases in the line of parents and grandparents, in 46 (45.1%) patients heredity was not burdened. The most frequent complaints registered in the case histories of patients were: 89 (87.3%) – headache, mainly in the occipital region; 18 (17.7%) – dizziness; 16 (15.7%) – stabbing pain in heart; 10 (9.8%) – increased heart rate. In 31 (28.4%) of the examined children, grade I AH was detected; in 56 (54.9%) – grade II AH; 6 (5.9%) – autonomic dysfunction syndrome; 9 (8.8%) had labile AH. As a drug antihypertensive monotherapy for the treatment of hypertension in children and adolescents in the Russian Federation, five main pharmacological groups are recommended: angiotensin-converting enzyme inhibitors (ACE inhibitors); angiotensin receptor blockers; β-blockers; calcium channel blockers (dihydropyridine); thiazide diuretics, which was confirmed by a retrospective analysis. Drug therapy for AH was prescribed to children after 6–12 months of ineffectiveness of non-drug therapy. Of the ACE inhibitors group, 46 (45.1%) patients were prescribed a drug enalapril, 5 (4.9%) – fosinopril, 2 (2%) – captopril. β-blockers 11 (10.7%) patients were prescribed bisoprolol, 1 (1%) patient – atenolol. From the group of angiotensin receptor blockers, 1 (1%) child was prescribed losartan, 1 (1%) – irbesartan. Calcium channel blockers were recommended for 1 (1%) patient as amlodipine. Diuretics were prescribed to 1 (1%) child with the drug indapamide.

Conclusion. Based on our study, it was found that angiotensin-converting enzyme inhibitors are the priority pharmacological group in the treatment of hypertension in children and adolescents.

Full Text

Restricted Access

About the authors

Liudmila V. Kozlova

Smolensk Regional Children's Clinical Hospital

Email: milkozlova@yandex.ru
ORCID iD: 0000-0003-0625-2877

D. Sci. (Med.), Prof.

Russian Federation, Smolensk

Anna V. Krikova

Smolensk State Medical University

Email: anna.krikova@mail.ru
ORCID iD: 0000-0002-5288-0447

D. Sci. (Pharmaceut.), Assoc. Prof.

Russian Federation, Smolensk

Olga S. Mikhailova

Smolensk State Medical University

Author for correspondence.
Email: vsegda8marta@rambler.ru
ORCID iD: 0000-0002-9562-4961

Graduate Student

Russian Federation, Smolensk

References

  1. Всемирная организация здравоохранения. Сердечно-сосудистые заболевания. Режим доступа: https://www.who.int/ru/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Ссылка активна на 11.03.2022 [World Health Organization. Cardiovascular diseases. Available at: https://www.who.int/ru/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed: 11.03.2022].
  2. Малков П.В., Баранов Э.Ф., Безбородова Т.С., и др. Российский статистический ежегодник. 2019. М.: Росстат, 2019. Режим доступа: https://rosstat.gov.ru/storage/mediabank/Ejegodnik_2019.pdf. Ссылка активна на 11.03.2022 [Malkov PV, Baranov EF, Bezborodova TS, et al. Rossiiskii statisticheskii ezhegodnik. 2019. Moscow: Rosstat, 2019. Available at: https://rosstat.gov.ru/storage/mediabank/Ejegodnik_2019.pdf. Accessed: 11.03.2022].
  3. Александров А.А., Кисляк О.А., Леонтьева И.В. от имени экспертов. Клинические рекомендации. Диагностика, лечение, профилактика артериальной гипертензии у детей и подростков. Системные гипертензии. 2020;17(2):7-35 [Aleksandrov AA, Kisliak OA, Leontyeva IV. Clinical guidelines on arterial hypertension diagnosis, treatment and prevention in children and adolescents. Systemic Hypertension. 2020;17(2):7-35 (in Russian)]. doi: 10.26442/2075082X.2020.2.200126
  4. Бекезин В.В., Козлова Л.В., Борсуков А.В., и др. Донозологическая диагностика первичной артериальной гипертензии у детей и подростков: факторы риска, первичная профилактика. Вестник Смоленской государственной медицинской академии. 2020;1:71-84 [Bekesin VV, Kozlova LV, Borsukov AV, et al. Principal diagnostics of primary arterial hypertension in children and adolescents: risk factors, primary prevention. Vestnik Smolenskoi gosudarstvennoi meditsinskoI akademii. 2020;1:71-84 (in Russian)].
  5. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. doi: 10.1542/peds.2017-1904
  6. Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887-920. doi: 10.1097/HJH.0000000000001039
  7. Dionne JM, Harris KC, Benoit G, et al. Hypertension Canada’s 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension. Can J Cardiol. 2017;33(5):557-688. doi: 10.1016/j.cjca.2017.03.007
  8. Леонтьева И.В. Лечение артериальной гипертензии у детей и подростков. Российский вестник перинатологии и педиатрии. 2019;64(1):15-24 [Leontyeva IV. Treatment of hypertension in children and adolescents. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2019;64(1):15-24 (in Russian)]. doi: 10.21508/1027-4065-2019-64-1-15-24
  9. Chu PY, Campbell MJ, Miller SG, Hill KD. Anti-hypertensive drugs in children and adolescents. World J Cardiol. 2014;6:234-44. doi: 10.4330/wjc.v6.i5.234
  10. Кисляк О.А. Оптимальная блокада ренин-ангиотензин-альдостероновой системы: современные принципы лечения артериальной гипертензии блокаторами ангиотензиновых рецепторов. Фарматека. 2005;20:34-9 [Kislyak OA. Optimal'naia blokada renin-angiotenzin-al'dosteronovoi sistemy: sovremennye printsipy lecheniia arterial'noi gipertenzii blokatorami angiotenzinovykh retseptorov. Farmateka. 2005;20:34-9 (in Russian)].
  11. Wells T, Frame V, Soffer B, et al. A double-blind, placebo-controlled, doseresponse study of the effectiveness and safety of enalapril for children with hypertension. J Clin Pharmacol. 2002;42:870-80. doi: 10.1177/009127002401102786
  12. Жаркова Л.П., Андреева И.В. Клиническое исследование эффективности и безопасности применения специфического антагониста рецепторов ангиотензина II ирбесартана при лечении артериальной гипертензии у детей и подростков. Вопросы современной педиатрии. 2007;6(3)24-7 [Zharkova LP, Andreeva IV. Efficacy and safe use of specific angiotensin II receptor antagonist irbesartan for curing arterial hypertension in children and teenagers: a clinical study. Current Pediatrics. 2007;6(3):24-7 (in Russian)].
  13. Белоусов Ю.Б. Место ирбесартана (апровеля) в лечении артериальной гипертензии у больных сахарным диабетом 2 типа. Фарматека. 2005;3:20-4 [Belousov YuB. Mesto irbesartana (aprovelia) v lechenii arterial'noi gipertenzii u bol'nykh sakharnym diabetom 2 tipa. Farmateka. 2005;3:20-4 (in Russian)].

Supplementary files

Supplementary Files
Action
1. Fig. 1. Dynamics of primary morbidity of circulatory system diseases on the territory of the Russian Federation [2].

Download (62KB)
2. Fig. 2. Distribution by sex and age of children and adolescents with arterial hypertension (AH) who participated in the study.

Download (53KB)
3. Fig. 3. Distribution according to the place of residence of the children and adolescents with AH who took part in the study.

Download (81KB)
4. Fig. 4. Clinical manifestations of AH in children and adolescents who participated in the study.

Download (56KB)
5. Fig. 5. Blood pressure profile of the examined children and adolescents with AH.

Download (159KB)
6. Fig. 6. Frequency of prescription of antihypertensive medications from a retrospective study in children and adolescents with AH.

Download (107KB)


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies