pediatrics
Drugs for Hypertension in Children
Angiotensin Converting Enzyme (ACE) Inhibitors
ACE inhibitors (see table Oral ACE Inhibitors for Hypertension in Children ) reduce BP by interfering with the conversion of angiotensin I to A dry, irritating cough is the most common adverse effect (much less common in children than in older patients), but angioedema is the most serious and, if it affects the oropharynx, can be fatal. Angioedema is most common among blacks and smokers. ACE inhibitors may increase serum potassium and creatinine levels, especially in patients with chronic kidney disease and those taking potassium-sparing diuretics, potassium supplements, or nonsteroidal anti-inflammatory drugs (NSAIDs). ACE inhibitors are contraindicated during pregnancy and should be used with caution in adolescent females who are at risk of pregnancy. In patients with renal disorders causing renal dysfunction, serum creatinine and potassium levels should be checked within 2 to 4 weeks of starting therapy. If the levels are increased, then they should be monitored at least every 3 to 6 months (more frequently if the increases are significant). ACE inhibitors can cause acute kidney injury in patients who have hypovolemia, severe heart failure, severe bilateral renal artery stenosis, or severe stenosis in the artery to a solitary kidney. Thiazide-type diuretics enhance the antihypertensive activity of ACE inhibitors more than that of other classes of antihypertensives.Spironolactoneandeplerenonealso appear to enhance the effect of ACE inhibitors. 