“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 .
“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
SBP or DBP Percentile
Prehypertension90th percentile to <95th percentile, or if BP exceeds 120/80 even if below the 90th percentile up to <95th percentile
Stage 1 hypertension95th percentile to the 99th percentile plus 5 mmHg
Stage 2 hypertension >99th percentile plus 5 mmHg
SBP (mmHg)DBP (mmHg)
Age BPPercentile of HeightPercentile of Height
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
Use of BP Medications
CRI Dialysis Transplant
LVH 22-31% 55-85% 30-75%
Hypertension and CKD Progression
NAPRTCS CRI Database:
Mitsnefes et al, J Am Soc Nephrol 2003
PrehypertensionDo not initiate therapy unless there are compelling indications such as chronic kidney disease (CKD), diabetes mellitus, heart failure, left ventricular hypertrophy (LVH).
Stage 1 hypertensionInitiate therapy based on indications
Stage 2 hypertensionInitiate therapy
All patients to receive Therapeutic Life-style Changes (TLC)
AstraZenecaFelodipine (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 BP
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
Does the benefit associated with treating hypertension in children
apply to adults?"