“Does the Benefit Associated with Treating Hypertension Apply to Children?" . Ronald Portman, MD Professor and Director Division of Pediatric Nephrology and Hypertension University of Texas -Houston Past-Chair, International Pediatric Hypertension Association .
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Ronald Portman, MD
Professor and Director
Division of Pediatric Nephrology and Hypertension
University of Texas -Houston
Past-Chair, International Pediatric Hypertension Association
SBP or DBP Percentile
Normal <90th percentile
Prehypertension 90th percentile to <95th percentile, or if BP exceeds 120/80 even if below the 90th percentile up to <95th percentile
Stage 1 hypertension 95th percentile to the 99th percentile plus 5 mmHg
Stage 2 hypertension >99th percentile plus 5 mmHg
SBP (mmHg) DBP (mmHg)
Age BP Percentile of Height Percentile of Height
(Year) Percentile 5th 10th 25th 50th 75th 90th 95th 5th 10th 25th 50th 75th 90th 95th
12 50th 102 103 104 105 107 108 109 61 61 61 62 63 64 64
90th 116 116 117 119 120 121 122 75 75 75 76 77 78 78
95th 119 120 121 123 124 125 126 79 79 79 80 81 82 82
99th 127 127 128 130 131 132 133 86 86 87 88 88 89 90
Death rate per 100,000
0-14 15-19 20-30
Adaptedfrom Parekh et al, J Pediatr, 2002
Prevalence of Hypertension/LVH in Children with CKD children and adolescents
Use of BP Medications
CRI Dialysis Transplant
LVH 22-31% 55-85% 30-75%
Hypertension and CKD Progression children and adolescents
NAPRTCS CRI Database:
Mitsnefes et al, J Am Soc Nephrol 2003
Pharmacologic Therapy children and adolescents
Prehypertension Do not initiate therapy unless there are compelling indications such as chronic kidney disease (CKD), diabetes mellitus, heart failure, left ventricular hypertrophy (LVH).
Stage 1 hypertension Initiate therapy based on indications
Stage 2 hypertension Initiate therapyClassification of Hypertension in Childrenand Adolescents: Therapy Recommendations
All patients to receive Therapeutic Life-style Changes (TLC)
AstraZeneca (FDAMA)Felodipine (Plendil)*Metoprolol (Toprol-XL)# Candesartan (Atacand)
Bristol-Myers Squibb Fosinopril (Monopril)**Irbesartan (Avapro)#
Boehringer Ingelheim Telmisartan (Micardis)
MerckEnalapril (Vasotec)*Lisinopril* (Prinivil/Zestril)Losartan (Cozaar)*
PfizerAmlodipine (Norvasc)*Eplerenone (Inspra)
Wyeth-Ayerst/KingBisoprolol-HCTZ (Ziac)*Altace (Ramipril)
ESCAPE Trial* Germany
Ramipril in CKD, proteinuria and BPRecent Pediatric Phase III or IV Antihypertensive Programs
Meta-analysis in progress
# completed; not yet published
The Agency can also promote studies in children by granting additional exclusivity for assessing the effects of antihypertensive drugs in children.Should they do this?
The Child is Father to the Man additional exclusivity for assessing the effects of antihypertensive drugs in children.
Does the benefit associated with treating hypertension in children
apply to adults?"