N-of-1 Trials In Children With Hypertension

Based on underlying comorbidities at enrollment, patients will be assigned to either an unrestricted protocol (amlodipine versus lisinopril) or a restricted protocol (losartan versus lisinopril). Two drugs are tested in randomized order. Failure to achieve BP control at maximum doses of the first two drugs will result in augmentation with a diuretic (hydrochlorothiazide). BP control is assessed with 24 hour ambulatory monitoring at the end of each 2 week treatment period. Side effect tolerability is assessed with a questionnaire.

Physician preference will dictate choice and adjustment of antihypertensive medication, BP measurement modality, interval between visits, and assessment of side effects.

Calcium-channel blocker; antihypertensive

Angiotensin-converting-enzyme (ACE) inhibitor; antihypertensive

Thiazide diuretic; antihypertensive

Angiotensin II receptor blocker (ARB); antihypertensive