411 - Prescribing Patterns in Pediatric Hypertension

Publication Number: 1394.411

Meghan McLaughlin, University of Rochester, Rochester, NY, United States; Conrad Gleber, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States

Background: In both pediatric and adult hypertension, guidelines recommend initial pharmacologic therapy with an angiotensin-converting enzyme inhibitor (ACEi), angiotensin II receptor blocker (ARB), calcium channel blocker, or diuretic. There is no single first line or preferred agent within these classes leading to variation in clinical practice. While there has been an emergence of new drugs and trials that have impacted adult hypertension management, there remains a paucity of pediatric clinical trial data.

Objective: We aimed to examine the prescribing patterns for antihypertensive drugs in pediatric and adult patients with hypertension.

Design/Methods: This is a retrospective cross-sectional study of patients with a diagnosis of hypertension who were prescribed an antihypertensive medication between 1/1/2020 and 12/31/2024 using the Epic Cosmos database. We examined the percentage of patients prescribed different classes of antihypertensive medications. Pediatric patients were defined as those less than or equal to 18 years of age. Adult patients were those greater than 18 years of age. Subgroup analyses of medications were performed to examine the most often prescribed medications within a specific class.

Results: A total of 107,884 pediatric patients and 30,501,837 adult patients with a diagnosis of hypertension were prescribed an antihypertensive during the study period. In comparing pediatric patients to adult patients, 46.0% vs 38.5% were on an ACEi, 12.5% vs 42.0% were on an ARB, 46.4% vs 50.5% were on a calcium channel blocker, 28.3% vs 48.1% were on a diuretic, and 26.8% vs 55.0% were on a beta blocker. A total of 4.2% vs 19.3% were on a combination antihypertensive medication. Of 49,601 pediatric patients on an ACEi, 82.0% were on lisinopril. Of the 16,151 pediatric patients on an ARB, 87.0% were on losartan. Of 49,727 pediatric patients on a calcium channel blocker, 83.7% were on amlodipine.

Conclusion(s): Prescribing patterns in pediatric and adult hypertension patients are varied. Despite a preferable side effect profile compared to ACEi, pediatric patients are less likely than adults to be prescribed an ARB. Very few pediatric patients were prescribed combination drugs though this is a strategy that can improve adherence. Most pediatric patients prescribed an antihypertensive drug are on lisinopril, losartan, and amlodipine. This data highlights the need for further research including pharmacologic studies to optimize pharmacologic management of pediatric hypertension.

Antihypertensive Prescribing Patterns in Pediatric vs Adult Patients
The figure demonstrates the percentage of pediatric vs adult patients prescribed a particular antihypertensive class out of the total patients prescribed an antihypertensive.