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

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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.

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About the authors

Liudmila V. Kozlova

Smolensk Regional Children's Clinical Hospital

ORCID iD: 0000-0003-0625-2877

D. Sci. (Med.), Prof.

Russian Federation, Smolensk

Anna V. Krikova

Smolensk State Medical University

ORCID iD: 0000-0002-5288-0447

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

Russian Federation, Smolensk

Olga S. Mikhailova

Smolensk State Medical University

Author for correspondence.
ORCID iD: 0000-0002-9562-4961

Graduate Student

Russian Federation, Smolensk


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Supplementary files

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

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

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

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4. Fig. 4. Clinical manifestations of AH in children and adolescents who participated in the study.

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5. Fig. 5. Blood pressure profile of the examined children and adolescents with AH.

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6. Fig. 6. Frequency of prescription of antihypertensive medications from a retrospective study in children and adolescents with AH.

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