Rahul Chanchlani: Building a Global Trial for Pediatric Hypertension
Evidence in pediatric nephrology, particularly in the treatment of hypertension (high blood pressure), remains limited in Canada and globally, leaving many clinical decisions without strong research guidance.
While other pediatric fields, such as cardiology, oncology, and critical care, have a long history of conducting high-quality clinical trials, pediatric nephrology has lagged behind. As a result, treatment choices are often guided by clinicians' experience and patients' preferences rather than by clear comparative evidence.
“Within pediatrics, certain conditions are more common, such as cancer, asthma, and developmental issues, compared to kidney conditions like hypertension. As a result, specialties such as pediatric cardiology, pediatric oncology, and pediatric critical care are much more advanced in conducting clinical trials than pediatric nephrology,” explains Dr. Rahul Chanchlani, an associate professor in the Division of Nephrology, Department of Pediatrics at McMaster Children’s Hospital.
Dr. Chanchlani, a pediatric nephrologist, is working to address this gap. Through his participation in the HDRN Canada pragmatic trials training program, he is developing a protocol for a pragmatic clinical trial comparing the effectiveness and safety of commonly used blood pressure medications in children aged 5 to 17. The study will begin in Canada, with plans to expand globally, generating real-world evidence to improve care for children in Canada and beyond.
A growing concern
High blood pressure in children can have serious long-term consequences. Children with poorly controlled hypertension are at increased risk of lifelong heart and kidney complications. At the same time, shifting demographics and rising risk factors—such as obesity and sedentary lifestyles—are contributing to a growing number of children with elevated blood pressure and related kidney conditions.
“We are seeing more children with hypertension; therefore, there is growing recognition that if we want to improve care and change how physicians practice, we need clinical trials, because they provide the highest level of evidence.”
What remains unclear, however, is how the medications currently used in practice compare to one another in real-world settings, an evidence gap that Dr. Chanchlani’s trial is designed to address.
Filling the Gap
In clinics across Canada and around the world, physicians treating children with hypertension typically choose from a small number of medication classes. “Historically, though, there have been very few high-quality trials comparing the effectiveness of these drugs,” says Dr. Chanchlani.
Over the past two decades, some studies have been conducted, but they have included small numbers of patients and have often been limited in design. Importantly, there has not yet been a pragmatic trial in this area.
Today, when prescribing these medications, pediatric nephrologists often weigh their own clinical experience alongside patient preferences, rather than relying on strong comparative evidence.
To address this, Dr. Chanchlani is designing a pragmatic trial protocol to answer key questions in his field: among commonly used antihypertensive medications in children, which works best in real-world practice? Which most effectively controls blood pressure? Which has the fewest side effects? And which is preferred by patients, families, and physicians?
Answering these questions requires large-scale collaboration. Because pediatric hypertension is relatively uncommon, individual centers may only contribute 10 to 20 patients. “If we want to enroll 600 children, we would need at least 10 to 15 strong centers. This isn’t something we can do in just one country,” he explains.
Dr. Chanchlani is developing this trial with the goal of collaborating with partners across Canada and internationally, including the United States, Europe, the United Kingdom, Australia, South Africa, and India, to run it across diverse clinical settings and embed it within routine care.
“The first step is to conduct a pilot study, because this hasn’t been done before, at least not in this field. We need to understand the landscape, can we recruit patients, and can we run this kind of trial smoothly within clinical settings?”
The initial pilot will likely take place in Canada, followed by a much larger, globally coordinated study.
For Dr. Chanchlani, this trial is only the beginning. “If we can successfully run this first study, the goal is to establish an International Consortium of Pediatric Hypertension Trials. The idea is to create a sustainable platform for future research. If someone in the United States has an important clinical question, we could answer it together. If a team in Asia has a different question, we could address that collaboratively as well.”
Dr. Chanchlani’s work contributes to more than a single study; his protocol under development is designed to lay the foundation for a global research platform that could transform how evidence is generated in pediatric nephrology and ensure that treatment decisions for children with hypertension are guided by robust, real-world evidence.
** The HDRN Canada pragmatic trials training program is coordinated and hosted by the Schulich School of Medicine & Dentistry and is an initiative by Health Data Research Network (HDRN) Canada. It has been funded with $3.48 million from the Canadian Institutes of Health Research (CIHR). Read more.
You can also watch this video for a brief overview of Dr. Chanchlani's work
