Antihypertensive Management in Children: A Two-years Experience of Indonesia’s National Referral Hospital

INTRODUCTION: The prevalence of hypertension (HT) in children has increased overtime. However, data related to antihypertensive options and outcomes are still limited in children, especially in Indonesia. This study aimed to describe pediatric HT cases and antihypertensive management in Cipto Mangunkusumo General Hospital (CMGH).
METHODS: A retrospective cross-sectional study was conducted in CMGH from January 2016 to December 2017. Inclusion criteria were children age <18 years with primary and secondary HT visiting pediatric nephrology clinic. Patients were excluded if no blood pressure records were found. Clinical and antihypertensive treatments data were recorded from medical records. Diagnosis was based on the Fourth Report classification.
RESULTS: This study included 176 children with HT. Secondary HT was found in 159 (90.3%) patients, and 82 (51.6%) of them had isolated kidney urinary tract disease. Dual antihypertensive therapy was prescribed for 53 (30.1%) patients, whereas 55 (31.3%) patients was monotherapy. The most common antihypertensive used in monotherapy was angiotensin converting enzyme inhibitors (ACEI), received by 31 (56.3%) patients. The median duration of therapy until achievement of target blood pressure was 28.0 (1.0-365.0) days.
DISCUSSION AND CONCLUSION: Pediatric HT is an often overlooked growing medical issue. Secondary HT was found more in children compare to primary HT. Secondary etiology was suspected if HT was found in children with kidney disease. The first-line antihypertensive drug used was ACEI, as single or combination therapy. The therapeutic effect of antihypertensive drugs was expected within 28 days of treatment.