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Antihypertensive drugs for outpatient management of

hypertension in children 1 to 17 years old (continued)

Class

Drug

Dose*

Dosing
interval

1. May cause dry

mouth and/or
sedation.

Children
12
years:
Central
alpha-agonist

Clonidine

Initial: 0.2
mg/d

twice daily

Initial: 1
mg/kg per
d
Maximum:
3 mg/kg
per d up
to 50 mg/d

once daily

Initial: 0.3
mg/kg per
d
Chlorthalidone

Maximum:
2 mg/kg
per d up
to 50 mg/d

2. Transdermal
preparation also
available.
3. Sudden
cessation of
therapy can lead to
severe rebound
hypertension.

Maximum:
2.4 mg/d

HCTZ

Comments

once daily

1. All patients
treated with
diuretics should
have electrolytes
monitored shortly
after initiating
therapy and
periodically
thereafter.
2. Useful as add-on
therapy in patients
being treated with
drugs from other
drug classes.

Print

Furosemide

Initial:
0.5-2.0
mg/kg per
dose
Maximum:
6 mg/kg
per d

Diuretic

Initial: 1
mg/kg per
d
Spironolactone

Maximum:
3.3 mg/kg
per d up
to 100
mg/d

once to
twice
daily

once to
twice
daily

Initial: 1-2
mg/kg per
d
Triamterene

Amiloride

Maximum:
3-4 mg/kg
per d up
to 300
mg/d
Initial:
0.4-0.625
mg/kg per
d

twice
daily

once daily

3.
Potassium-sparing
diuretics
(spironolactone,
triamterene,
amiloride) may
cause severe
hyperkalemia,
especially if given
with ACE inhibitor
or ARB.
4. Furosemide is
labeled only for
treatment of
edema but may be
useful as add-on
therapy in children
with resistant
hypertension,
particularly in
children with renal
disease.
5. Chlorthalidone
may precipitate
azotemia in
patients with renal
diseases and
should be used
with caution in
those with severe
renal impairment.

Maximum:
20 mg/d

ARB: angiotensin-receptor blocker; HCTZ: hydrochlorothiazide; d: day.

* The maximum recommended adult dose should not be eceeded in
routine clinical practice.
Comments apply to all members of each drug class except where
otherwise stated.
Includes drugs with prior pediatric experience or recently completed
clinical trials.
Data from: National High Blood Pressure Education Program Working Group
on High Blood Pressure in Children and Adolescents. The fourth report on the
diagnosis, evaluation, and treatment of high blood pressure in children and

adolescents. Pediatrics 2004; 114 (2 Suppl 4th Report):555.

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