Primary Hypertension in Childhood

Abstract

There is growing concern about elevated blood pressure in children and adolescents, because of its association with the obesity epidemic. Moreover, cardiovascular function and blood pressure level are determined in childhood and track into adulthood. Primary hypertension in childhood is defined by persistent blood pressure values ≥ the 95th percentile and without a secondary cause. Preventable risk factors for elevated blood pressure in childhood are overweight, dietary habits, salt intake, sedentary lifestyle, poor sleep quality and passive smoking, whereas non-preventable risk factors include race, gender, genetic background, low birth weight, prematurity, and socioeconomic inequalities. Several different pathways are implicated in the development of primary hypertension, including obesity, insulin resistance, activation of the sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system and altered vascular function. Prevention of adult cardiovascular disease should begin in childhood by regularly screening for high blood pressure, counseling for healthy lifestyle and avoiding preventable risk factors.

Sodium Consumption in Southeast Asia: An Updated Review of Intake Levels and Dietary Sources in Six Countries

“…A meta-analysis of controlled trials on infants and children [ 13 ] showed that 54 % reduction in salt intake among infants (aged newborn to 3 months old) resulted in a signifi cant decrease in systolic blood pressure (−2.47 mmHg; p < 0.01), while 42 % salt intake reduction among children aged [8][9][10][11][12][13][14][15][16] years resulted in reduced systolic blood pressure (−1.17 mmHg, p < 0.001) and reduced diastolic blood pressure (−1.29 mmHg, p < 0.0001). It is now recognized that blood pressure in childhood tracks into adulthood, and although a positive sodium balance is needed for growth during the fi rst year of life, a low salt diet for older children and adolescents has been shown to have the same cardiovascular protective effects as for adults [ 14 -16 ].…”

Arterial hypertension in children

“…Consequently, these cardiovascular complications first appear in adulthood, indicating that is not possible to directly link BP levels in childhood with cardiovascular disease risk in adulthood. Nevertheless, a correlation between BP and surrogate markers of target-organ damage, such as left ventricular hypertrophy, arterial stiffness or increased urinary protein excretion, is demonstrable in children with arterial hypertension [3]. Severe hypertension in childhood mainly results from secondary causes, such as cardiac or renal disease.…”

“…The most significant long-term consequence of elevated BP in childhood is the ongoing hypertension into adulthood (tracking of BP [5]), therefore causing cardiovascular, cerebrovascular and renal disease later in life [3,5,6,21,22]. The most evident target-organ damage during childhood and adolescence is left ventricular hypertrophy [8,9].…”

“…Although hypertension is less common in children than in adults, there is growing concern about elevated blood pressure (BP) and hypertension in children and adolescents because of the association of elevated BP with the overweight epidemic [2,3]. Moreover, it has been hypothesized that cardiovascular functions are determined in childhood and track into adulthood.…”

“…Moreover, it has been hypothesized that cardiovascular functions are determined in childhood and track into adulthood. Children with high BP values have a greater risk to have high (or too high) BP levels in adulthood, as indicated by the fact that almost half of adults with arterial hypertension had high BP values in childhood [3][4][5]. Tracking of BP begins in early childhood, at about the age of 5 years [6].…”