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Table 4 Drugs useful in the treatment of neonatal hypertension

From: Novelty in hypertension in children and adolescents: focus on hypertension during the first year of life, use and interpretation of ambulatory blood pressure monitoring, role of physical activity in prevention and treatment, simple carbohydrates and uric acid as risk factors

Drug Class Dose Route Comments
Intravenous agentsa:
Diazoxide Vasodilator (arteriolar) 2–5 mg/kg/dose Rapid bolus injection Slow injection is ineffective.
Duration unpredictable.
May cause rapid hypotension.
Enalaprilat ACE-inhibitor 15 ± 5 μg/kg/dose; repeat after 8–24 h Injection over 5–10 min May cause prolonged hypotension and acute renal insufficiency.
Esmolol β-blocker 100–300 μg/kg/min IV infusion Very short-acting. Constant infusion necessary.
Hydralazine Vasodilator (arteriolar) Bolus: 0.15–0.6 mg/kg/dose every 4 h.
Drip: 0.75–5.0 μg/kg/min
IV bolus or infusion Frequently causes tachycardia.
Labetalol α- and β-blocker 0.20–1.0 mg/kg/dose
0.25–3.0 mg/kg/h
IV bolus or constant infusion Heart failure and BPD are relative contraindications.
Nicardipine Calcium antagonist 1–3 μg/kg/min Constant infusion May cause reflex tachycardia.
Sodium nitroprusside Vasodilator (arteriolar and venous) 0.5–10 μg/kg/min Constant infusion In case of prolonged therapy (>72 h) or renal failure thiocyanate toxicity may occur.
Drug Class Dose Interval Comments
Oral agentsa
Captopril ACE-inhibitor 0.01–0.5 mg/kg TID Monitor serum creatinine and potassium.
Clonidine Central α-agonist 0.05–0.1 mg/kg? BID-TID Side effects: sedation, dryness of the mucosa. Abrupt interruption may cause rebound hypertension.
Hydralazine Vasodilator (arteriolar) 0.25–1.0 mg/kg (max 7.5 mg/kg per day) TID-QID Frequent side effects: fluid retention and tachycardia. Lupus-like syndrome may occur in slow acetylators.
Isradipine Calcium antagonist 0.05–0.15 mg/kg QID Useful for both chronic and acute hypertension.
Amlodipine Calcium antagonist 0.1-0.3 mg/kg BID Causes sudden hypertension less frequently than isradipine.
Nifedipine Calcium antagonist 0,25–0,5 mg/kg
Max. dose: 1–2 mg/kg per day
Repeat every 4–6 h Hypotensive response poorly predictable.
Minoxidil Vasodilator (arteriolar) 0.1–0.2 mg/kg BID-TID The most potent oral vasodilator. Hypertrichosis in case of prolonged use.
Propranolol β-blocker 0.5–1.0 mg/kg TID Maximum dose to be defined according to heart rate (up to 8–10 mg/kg if no bradycardia). Not to be used in infants with BPD.
Atenolol β-blocker 0.8–1 mg/kg
Max. dose 2 mg/kg per day
QD  
Labetalol α- and β-blocker 1.0 mg/kg BID-TID Monitor heart rate. Not to be used in infants with BPD.
Spironolactone Aldosterone antagonist 0.5–1.5 mg/kg BID Potassium-sparing. Check serum electrolytes. May take several days to reach maximum effectiveness.
Hydrochlorothiazide Thiazide diuretic 1–3 mg/kg QID Check serum electrolytes.
Chlorothiazide Thiazide diuretic 5–15 mg/kg BID Check serum electrolytes.
  1. amodified from Flynn, [6]