Anti-hypertensive drugs in children and adolescents

Table 1 Anti-hypertensive class effects

Drug class	Special indications	Precautions	Contraindications	Common adverse events
Angiotensin converting enzymeinhibitors	Proteinuria Chronic kidney disease	Less efficacious in blacks Risk of angioedema, increase risk of hyperkalemia Decreased glomerular filtration rate	Prior history of angioedema with use of ACE inhibitor Discontinue if pregnant: Pregnancy class C in 1st trimester, pregnancy class D in 2nd and 3rd trimester	Headache Dizziness Abdominal pain Nausea Cough
Angiotensin receptor blockers	Proteinuria	Less efficacious in blacks Increase risk of hyperkalemia Decreased GFR	Discontinue if pregnant: Pregnancy class C in 1st trimester, pregnancy class D in 2nd and 3rd trimester	Headache Dizziness Cough
Calcium channel blockers	None	Drug interactions with compounds that change cytochrome P450s metabolism (i.e.: Azole antifungals, grapefruit juice, anti-seizure medications)	Pregnancy class C	Headache Peripheral edema Fatigue Dizziness Abdominal pain Epistaxis
Beta blockers	None	Increased risk of bronchoconstriction in asthma	Severe bradycardia Heart block greater than first degree Cardiogenic shock Decompensated cardiac failure	Headache Cough Nasopharyngitis Fatigue Diarrhea Dizziness

Pregnancy class C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks; Pregnancy class D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks; ACE: Angiotensin converting enzyme.