Version June 2024
| Drug | Route* | Dose | Onset of action | Duration of action | Mechanism of action | Comments |
| Clonidine | Oral | 2 to 5 mcg/kg per dose up to 10 mcg/kg per dose (maximum single dose 0.1 mg) every 6 to 8 hours | 15 to 30 minutes | 6 to 8 hours | Central alpha2 adrenergic and imidazoline agonist | Effective dose for acute hypertension in infants and toddlers is not known |
| Hydralazine | Oral | 0.25 mg/kg per dose (maximum single dose 25 mg) | 30 min | 2 to 8 hours | Direct vasodilator | Variable response |
| Isradipine | Oral | 0.05 to 0.1 mg/kg per dose (maximum single dose 5 mg) | <1 hour | 6 to 8 hours | Calcium channel blocker | Stable oral suspension can be compounded |
| Minoxidil | Oral | 0.1 to 0.2 mg/kg per dose (maximum single dose 10 mg) | 1 hour | 8 to 12 hours | Direct arterial vasodilator | Most potent oral vasodilator with longest duration of action |
Oral medication therapy is appropriate for children with chronic hypertension due to a known condition (eg, chronic kidney disease) in which blood pressure has increased gradually over time and for whom lowering of the blood pressure should occur less quickly (eg, over 1 to 2 days or more). When the urgency arises from an acute process with a rapid change in mean arterial pressure (eg, acute glomerulonephritis) and associated symptoms, intervention should occur promptly (ie, within hours). For these children, we suggest intravenous (IV) bolus antihypertensive medications (refer to UpToDate content on IV medications for pediatric hypertensive emergencies).
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