Grant: Project Grant

High blood pressure affects about 1 in 20 children and is becoming more common. Children with high blood pressure often remain affected as adults, increasing their risk of heart and kidney disease later in life. When healthy lifestyle changes are not enough, medications are used to lower blood pressure. However, there is little research to guide doctors on which medication should be started first in children. As a result, children with similar health problems may receive different treatments depending on where they are seen or which doctor they visit. This study, called PACE-BP, will test whether it is possible and safe to run a larger national study comparing commonly used blood pressure medicines in children. In this pilot study, children who need medication for high blood pressure will be randomly assigned to start one of three commonly used types of blood pressure medicines that are already prescribed in routine care. Their doctors will continue to manage treatment as they normally would, and children will not need extra clinic visits beyond usual care. The main goal of this pilot study is not to decide which medicine is best, but to make sure a larger study can be done successfully. We will examine how well families agree to participate, whether children stay on their assigned treatment, how complete blood pressure information is during regular clinic visits, and whether follow-up is possible. We will also carefully monitor side effects and safety. By confirming that this type of study can be done safely and efficiently, PACE-BP will prepare the way for a larger trial that can help doctors, families, and health systems choose the best first medication for children with high blood pressure and improve long-term heart and kidney health.