Oral Angiotensin II Receptor Blockers (ARBs) for Hypertension in Children

For children 1–5 years of age: Initial dose 0.2 mg/kg once a day (up to a maximum dose of 0.4 mg/kg once a day or 0.2 mg/kg twice a day)

For children ≥ 6 years who weigh < 50 kg: Initial dose 4 mg once a day up to a maximum dose 16 mg once a day (or 8 mg twice a day)

For children ≥ 6 years who weigh ≥ 50 kg: Initial dose 8 mg once a day up to a maximum dose of 32 mg once a day (or 16 mg twice a day)

Common adverse effects: Headache, dizziness

Severe adverse effects: Fetal toxicity, hyperkalemia, acute kidney injury

Contraindications include pregnancy and angioedema.

The blood pressure–lowering ability of ARBs is equal to that of angiotensin-converting enzyme inhibitors (which are usually used first because there is more clinical experience).

ARBs do not cause cough, and angioedema is less frequent.

ARBs are usually given once a day, but twice daily dosing at a lower dose may be considered when an adverse effect, such as dizziness resulting from hypotension, occurs after a single larger daily dose.

For children ≥ 6 years of age: Initial dose 0.7 mg/kg once a day up to 50 mg once a day. Titrate up to a maximum daily dose of 1.4 mg/kg not to exceed 100 mg (alternatively 0.7 mg/kg or 50 mg twice a day)

For children ≥ 6 years of age: Initial dose 1.3 mg/kg once a day (maximum initial dose 40 mg once a day); maximum daily dose 2.7 mg/kg not to exceed 160 mg once a day