High blood pressure (hypertension) is persistently high pressure in the arteries. Some children who have high blood pressure need drugs to lower it.
(See also High Blood Pressure in Children.)
In children under 13 years of age, the values that are considered high vary based on sex, age, and height. Thus, there is no clear-cut blood pressure that indicates high blood pressure for all children. Rather, if blood pressure is the same as or higher than 90% of the blood pressure of children who are the same sex, age, and height, elevated blood pressure is diagnosed.
In adolescents (13 years of age or over), blood pressure is classified as it is in adults:
Normal: Lower than 120 systolic blood pressure and lower than 80 diastolic blood pressure
Elevated: 120 to 129 systolic blood pressure and lower than 80 diastolic blood pressure
Stage 1 (mild) high blood pressure: 130/80 to 139/89)
Stage 2 high blood pressure: 140/90 or higher
Immediate drug treatment (plus lifestyle changes) is typically started if any of the following apply:
High blood pressure, regardless of severity, causes symptoms.
Stage 1 hypertension causes organ dysfunction or damage.
Stage 2 hypertension is present.
Children have chronic kidney disease, diabetes, or heart disease regardless of the stage of high blood pressure.
Children who have milder forms of high blood pressure that are not controlled after about 6 months of lifestyle changes will need drug treatment.
Drugs that are used in the treatment of high blood pressure are called antihypertensive drugs. Treatment is most effective when the parents, child, and doctor communicate well and discuss the drug treatment program, including possible side effects. Any antihypertensive drug can have side effects, so parents should be alert for them. If side effects develop, parents or the child should tell the doctor, who can adjust the dose or substitute another drug.
Doctors typically start antihypertensive drugs, given by mouth, at a low dose and increase the dose as needed to lower blood pressure until the maximum dose of the drug is reached or side effects occur. If blood pressure is still too high, doctors may give children a second drug or switch drugs.
There are many types of antihypertensive drugs. Categories include
The different types of antihypertensive drugs work in different ways, so there are many options for treatment. It is not unusual for someone who has high blood pressure to be prescribed more than one of the drugs.
Some Antihypertensive Drugs* for High Blood Pressure in Children
Type | Examples | Some Side Effects |
|---|---|---|
Beta-blocker | Slow heart rate, problems with electrical conduction in the heart, dizziness, fatigue, or wheezing (when given at high doses) | |
Alpha-agonist | Drowsiness, fatigue, dizziness | |
Alpha-beta blocker | Low blood pressure when the child stands, swelling, slow heart rate | |
— | Common side effects: Cough, headache, dizziness Severe side effects: Serious injury to a fetus, increased potassium level in the blood, kidney injury, angioedema (allergic swelling that affects the face, lips, and windpipe and may interfere with breathing) | |
— | Common side effects: Headache, dizziness Severe side effects: Serious injury to a fetus, increased potassium level in the blood, kidney injury | |
Dihydropyridines | Common side effects: Flushing, dizziness, swelling of the lower legs or hands Severe side effect: Angioedema | |
— | Common side effects: Dizziness, decreased potassium level in the blood, increased blood sugar Severe side effects: Heart rhythm changes, sudden yellowing of the skin and eyes (jaundice), pancreatitis | |
Direct | Headache, dizziness | |
Common side effects: Dizziness, hairiness, fluid retention Severe side effects: Heart failure, fluid retention in the lungs (pulmonary edema), Stevens-Johnson syndrome | ||
* These drugs are given by mouth. | ||
Adrenergic blockers
Beta-blockers are the most commonly used adrenergic blockers.
Alpha-blockers are no longer used as the main treatment of high blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers
Calcium channel blockers cause arterioles to dilate by a completely different mechanism. These drugs may be short-acting or long-acting. Short-acting calcium channel blockers are not used to treat high blood pressure.
Thiazide diuretics
Thiazide diuretics cause potassium to be excreted in the urine, so potassium supplements sometimes must be taken with a thiazide diuretic.
Vasodilators
Direct vasodilators dilate blood vessels by another mechanism. A drug of this type is almost never used alone. Rather, a vasodilator is added as a second or third drug when another drug alone does not lower blood pressure sufficiently.
