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PEDIATRICS

Candesartan Cilexetil Effectively Reduces Blood Pressure in Hypertensive Children

Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR

Catherine E O'Brien, PharmD

Clinical Pharmacology Fellow, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences

Cindy D Stowe, PharmD

Associate Professor and Associate Dean for Academic Affairs, College of Pharmacy, University of Arkansas for Medical Sciences

Thomas G Wells, MD

Professor, Department of Pediatrics, Section of Clinical Pediatric Pharmacology and Toxicology, University of Arkansas for Medical Sciences; Arkansas Children's Hospital, Little Rock

Stephanie F Gardner, PharmD EdD

Professor and Dean, College of Pharmacy, University of Arkansas for Medical Sciences

Reprints: Dr. Franks, 4301 W. Markham St., #522, Little Rock, AR 72205, fax 501/296-1168, AFranks{at}uams.edu

BACKGROUND: The angiotensin-receptor blocker candesartan cilexetil is a well-tolerated antihypertensive agent with demonstrated benefits in adults with hypertension. However, there are few data supporting its use in children with hypertension.

OBJECTIVE: To determine the efficacy and tolerability of candesartan cilexetil in the treatment of pediatric hypertension.

METHODS: In an open-label, uncontrolled pilot study, hypertensive pediatric patients were eligible for participation if untreated systolic and/or diastolic blood pressure (BP) exceeded the 95th percentile for sex, age, and height. Patients underwent a 7-day washout period prior to initiation of weight-based dosing of candesartan cilexetil (2–8 mg daily). The dose was doubled after 7 days of therapy if inadequate antihypertensive response was determined by clinic-measured casual BP monitoring (CBPM) and home BP monitoring (HBPM). Three methods of BP measurement were compared before and after 2 weeks of treatment with the final dose of candesartan cilexetil: CBPM, HBPM, and 24-hour continuous ambulatory BP monitoring (ABPM). Self-reported adverse effects and clinical laboratory analyses were used to determine tolerability.

RESULTS: Eleven patients (mean age 14.2 y) received a final candesartan cilexetil median daily dose of 8 mg (0.13 mg/kg, range 2–16 mg). Study treatment resulted in significant reductions in systolic and diastolic BP as measured by CBPM (–7.4%, p = 0.03 and –5.9%, p = 0.01, respectively) and by ABPM (–6.0%, p = 0.03 and –10.8%, p = 0.006, respectively), but no significant reductions as measured by HBPM. No clinically significant changes in laboratory measures were observed, and patients reported nonspecific mild adverse effects.

CONCLUSIONS: Candesartan cilexetil effectively reduced BP as demonstrated by CBPM and ABPM measurements and was well tolerated in this group of hypertensive children.

Key Words: blood pressure, candesartan cilexetil, children, hypertension

Published Online, July 29, 2008. www.theannals.com, DOI 10.1345/aph.1L212