Context: Despite the tremendous increase in the number of antihypertensive agents available, extremely limited data regarding their use in pediatric patients (pts) exists.

Objective: To determine the dosing parameters, efficacy and safety of the second generation CCB, amlodipine, in the treatment of secondary hypertension(HTN) in children.

Background: Amlodipine is a potentially attractive therapy for pediatric HTN. The pills are small and crushable without affecting absorption or pharmacokinetics. The long half life allows for daily or bid dosing. Additionally, cyclosporine (CyA) metabolism is minimally affected. While the renal protective properties of ACE inhibitors are well established, CCBs are excellent alternatives. Specifically, CyA-associated HTN may benefit from CCB therapy because of afferent arteriolar dilating effects.

Methods: Retrospective study of pediatric pts with secondary forms of HTN treated with amlodipine. Amlodipine was selected as the first line agent in pts taking CyA. Those pts with uncontrolled HTN not taking CyA, received amlodipine as a second line agent.

Results: 36 pts, (15 months-18 years old (yo) mean 10.9yo;17 males, mixed racial population) received amlodipine treatment. Primary diagnoses included: 15 kidney txn, 6 CyA-treated FSGS, 5 ESRD, 3 liver txn, and 7 other. 36% of pts received amlodipine monotherapy, with combination therapy in the remainder. The mean dose of amlodipine employed was 0.43 mg/kg/day (0.06-1.54 mg/kg/day). Those pts ≤ 5yo required higher doses than older children(0.82±0.20 vs 0.33±0.05mg/kg/day; p 0.0029) to achieve BP control. Target BP, defined as systolic blood pressure less than the 95th% for height, was achieved in 92% of monotherapy pts, 84% of combination therapy pts, and 86% of all treated pts after the addition of amlodipine. To achieve target BP 22% of pts required a single daily dose and 78% required bid dosing. Side effects were noted in 11% of pts: 8% with palpitations, 3% with hirsuitism. None of the other common side effects of CCB's were observed.

Conclusion: 1.Amlodipine is an effective and safe therapy for pediatric hypertensive patients.

2. Patients younger than 5 years of age require higher doses of amlodipine for BP control.