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

Objectives 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). Methods 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. Results 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. Conclusions 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.