Clinical utility of valsartan in treatment of children and adolescents with high blood pressure

The incidence of hypertension in the pediatric population has been increasing secondary to lifestyle changes in children and adolescents. Recent studies have enhanced our understanding of the treatment of pediatric hypertension. Angiotensin-converting enzyme inhibitors have traditionally been the most commonly used class of medication in children with hypertension. This is partly due to the important role of the renin angiotensin aldosterone system pathway in the mediation of pediatric hypertension. Angiotensin receptor blockers provide a reasonable alternative to angiotensin-converting enzyme inhibitors. The need for better tolerated antihypertensives had led to development of many new antihypertensives. Valsartan is a relatively novel angiotensin receptor blocker that has been shown to be effective in the treatment of pediatric hypertension. Two recent trials have demonstrated the efficacy of valsartan monotherapy in the pediatric population aged 1–16 years. Once-daily oral preparations of valsartan achieve adequate blood pressure control in the pediatric population. Lack of generic formulations is an important disadvantage. Plasma levels are predictable and clearance is primarily by the liver. Valsartan should be prescribed cautiously for sexually active adolescent females due to concern about angiotensin receptor blocker fetopathy. Otherwise, the drug has infrequent side effects. In summary, valsartan is a new and useful alternative to conventional antihypertensive therapy in pediatric population.