# Pediatric oral antihypertensive agents: analysis of prescription patterns and patient characteristics in a real-world study

## TL;DR

This study examines how antihypertensive medications are prescribed to children, finding inconsistencies in dosing and suggesting the need for updated guidelines.

## Contribution

The study provides real-world insights into pediatric antihypertensive prescription patterns and highlights sex-specific differences in drug use.

## Key findings

- Prescription intensity and dosing of antihypertensives in children show inconsistencies, with significant variation in DUI values across drug classes.
- Males showed borderline higher DUI values compared to females, indicating potential sex-specific differences in medication use.
- Once-daily formulations were predominantly prescribed, but dosing remains inconsistent, suggesting a need for guideline updates.

## Abstract

The aim of this study was to assess prescribing intensity and rational dosing of antihypertensives in children using Defined Daily Dose (DDD) and Drug Utilization Index (DUI).

A retrospective cross-sectional analysis was conducted on all antihypertensive prescriptions dispensed at a tertiary children's hospital from May 2023 to April 2024, excluding those with incomplete data or on fixed-dose combinations. Prescription medicine use is basically reasonable when DUI is close to 1 (0.9–1.1), a DUI >1.1 suggests that the actual daily dose exceeds DDD, while a DUI <0.9 indicates underdosing. Statistical analysis was performed using SPSS 23.0 with significance at p < 0.05.

A total of 1,562 prescriptions for 422 children (12–18 years; 76.30% male) were analysed; prevalence peaked at 13 years. Among over-12-year-olds, DUI <0.9 for β-blockers, spironolactone and nifedipine; DUI ≈ 1 for furosemide, captopril and losartan; DUI >1.1 for hydrochlorothiazide, amlodipine, ramipril and fosinopril. Amlodipine comprised 42.8% of total DDDs, followed by fosinopril (25.6%) and ramipril (20.0%). Males showed borderline higher DUI values.

Hypertension was most prevalent among 13- to 14-year-old, who also exhibited the highest antihypertensive exposure and drug-use intensity relative to girls. Once-daily formulations accounted for the majority of prescriptions. Pediatric oral hypertension dosing remains inconsistent in clinical practice. These findings support sex-specific management and guideline updates to improve blood pressure control in high-risk adolescents.