A single pediatric center experience with 1025 children with hypertension

Wyszyńska, T; Cichocka, Edyta; Wieteska-Klimczak, Anna; Jobs, Katarzyna; Januszewicz, Paweł

doi:10.1111/j.1651-2227.1992.tb12213.x

Cited by 160 publications

(74 citation statements)

References 5 publications

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“…1 In contrast to high BP presenting in adulthood, which is mainly attributed to essential hypertension, secondary hypertension is the main etiology among children, reaching a prevalence of 98% among children younger than 15 years. 2 Renal parenchymal disease is the etiology among most patients presenting between the ages of 6 and 10 years with hypertension. 3 Other etiologies include renal vascular disease, aortic coarctation, and more rarely systemic arteritis; tumors such as neuroblastoma and Wilms tumor; endocrine diseases such as adrenocortical hyperfunctioning states, reninoma, thyrotoxicosis, pheocromocytoma; and finally neurologic disorders.…”

Section: Discussionmentioning

confidence: 99%

Spontaneously Resolving Hyperreninemic Hypertension Caused by Accessory Renal Artery Stenosis in a 13‐Year‐Old Girl: A Case Report

Akbeyaz

Tirosh

Robinson

et al. 2016

J of Clinical Hypertension

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The authors describe the clinical investigation and progress of a 13-year-old girl diagnosed with hypertension 4 years prior to her admission. A thorough history was taken and physical examination performed. Laboratory analysis and relevant radiological evaluation were obtained in order to determine the etiology for suspected secondary hypertension, and later to differentiate between the possible causes of hyperreninemic hypertension. The patient had an accessory left renal artery, presumptively leading to renin secretion by the underperfused kidney. The patient was treated medically with spontaneous resolution of her hypertension and near normalization of plasma renin activity. On repeat imaging, the artery was not demonstrated. The authors concluded that the diagnosis of hyperreninemic hypertension in young ages should prompt investigation for the etiology. However, cautious observation is a valid option that might lead to spontaneous resolution. J Clin Hypertens (Greenwich). 2017;19:100-102. Published 2016. This article is a U.S. Government work and is in the public domain in the USA CASE REPORTWe describe a 13-year-old girl diagnosed with hypertension. The patient complained of severe headaches since the age of 7 years. After 2 years, a diagnosis of hypertension, with blood pressure (BP) values up to 170/90 mm Hg (height-and age-adjusted 95th percentile 119/79 mm Hg), was determined. Her parents had no relevant medical history, whereas the mother's sister (aged 37 years) experienced migraines. In addition, both the paternal grandmother and great-grandmother had hypertension presenting during adulthood (>60 years). In light of the high BP values, target organs had been evaluated, including fundoscopy that revealed a mild bilateral hypertensive retinopathy and echocardiography that demonstrated changes secondary to systemic hypertension with preserved left ventricular function. Treatment with amlodipine was initiated and later replaced with enalapril, achieving normal BP values.During her initial evaluation in the community, the patient underwent investigation for secondary hypertension etiologies. This included kidney and renal arteries ultrasonography with Doppler, 24-hour urinary collection for vanilmandelic acid, and thyroid function tests, which were all within reference ranges. In contrast, both plasma aldosterone (PA) levels (89.4 ng/ mL; reference range, 1.5-50) and plasma renin activity (PRA; 13.9 ng/mL/h; reference range, 0.1-2.8) were elevated, as was chromogranin A plasma level (152 ng/ mL; reference range, 31-94). Thus, the workup focused on finding the etiology for excessive renin production, and included angiographic computerized tomography (CT) of the renal arteries, which was interpreted as a narrowing of the left renal vein. The patient was then referred for evaluation at the National Institutes of Health (NIH) clinical center for further evaluation.The patient first admitted to the NIH Clinical Center complaining of fatigue and headaches. Her BP was 106/ 54 mm Hg (between 50th and 90th perce...

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Section: Discussionmentioning

confidence: 99%

Spontaneously Resolving Hyperreninemic Hypertension Caused by Accessory Renal Artery Stenosis in a 13‐Year‐Old Girl: A Case Report

Akbeyaz

Tirosh

Robinson

et al. 2016

J of Clinical Hypertension

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“…Renal parenchymal diseases are recognized as the leading cause of secondary HPT [39] [40]. The high frequency of acute tubular necrosis is probably related to the high prevalence of intravascular hemolysis with hemoglobinuria in our setting.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Hypertension in Two University Hospitals in Cotonou, Benin: Presentation, Etiology, Management and Outcome

Lalya¹,

Adedemy²,

Tohodjèdé³

et al. 2018

OJPed

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Background: Hypertension (HPT) is a major public health problem. Many studies have attempted to investigate HPT in school children. Few, however, have targeted hospital HPT. We conducted this study to describe the epidemiologic characteristics, etiologies, management, and outcome of hospital HPT in our setting. Methods: This was a prospective and descriptive study carried out from March 01 through June 30, 2017 in the pediatric departments of two university hospitals: Centre National Hospitalier Universitaire Hubert K. Maga and Centre Hospitalier Universitaire de la Mère et de L'Enfant Lagune of Cotonou, Benin. Every consecutive patient aged 3 to 18 years who was admitted to the two hospitals for any reason had his (her) BP measured. Every patient with HPT was reviewed for demographics, history and clinical examination, and laboratory investigations as appropriate. Management was done accordingly. Outcome was also recorded. Results: The hospital frequency of HPT was 1.98% (31 cases/1565 admissions). The male/female ratio was 1.06 (16 males, 15 females). Mean age was 8.5 years ± 4.39 (range, 3 to 16 years). 74.19% patients had Body mass index within −2SD and +2SD. Only one patient had BMI above +3SD. The main etiologies found were renal: acute tubular necrosis (45.16%), acute glomerulonephritis (16.13%), and acute pyelonephritis (12.90%). Diuretics (64.5%), were the main antihypertensive drugs used. A single drug therapy was used in 35.4%, a two-drug therapy in 32.2% and a three-drug therapy in 9.6% of cases. Length of hospital stay was more than one week in 70.97% of cases. Hospital death rate for HPT was 19.35%. The outcome was not known in one patient due to exit from hospital against medical advice. All the other patients fully recovered at one month post-discharge HPT presents as a symptomatic disease in our hospitals; it has a renal etiology in most cases and has significant death rate despite treatment. Advocacy with health authorities must be the way out of issues of HPT management in our setting.

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“…26,30 Although clinical trials examining the effects of blood pressure control in children with renal disease have not yet been conducted, given the known benefits of blood pressure control in adults with renal disease, it is reasonable to assume that most pediatric nephrologists would choose to treat hypertension in children with underlying renal disease. This would add another category of hypertensive children to the category of those in whom placebo use should be considered unethical.…”

Section: Flynn Placebo Use In Pediatric Antihypertensive Trialsmentioning

confidence: 99%

Ethics of Placebo Use in Pediatric Clinical Trials

Flynn

2003

Hypertension

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Abstract-Industry-sponsored pediatric clinical trials of antihypertensive medications have greatly increased in number since passage of the Food and Drug Modernization Act of 1997. This development should ultimately benefit the treatment of hypertensive children by increasing the amount of scientific knowledge regarding the efficacy and safety of antihypertensive agents in children. However, the designs of many of these trials raise ethical questions related to the inclusion of placebo controls, a practice that has largely been abandoned in trials of antihypertensives in adults because of the well-known adverse consequences of untreated hypertension. This is an especially important issue in pediatric hypertension, as many hypertensive children have either secondary forms of hypertension or hypertension-induced target organ damage, potentially increasing the risk of harm during exposure to placebo. Against this background, and with a strong emphasis on protection of this vulnerable patient population, a strict set of conditions for use of placebos in pediatric antihypertensive trials is proposed. • the possibility of increased risk to both healthy research subjects and subjects with disease;• the need to obtain "informed assent" from older children and adolescents;• the possibility that research risks will be unequally distributed across the pediatric population (and the related issue that only a small number of children will have the opportunity to participate in research); and • how to recruit and compensate pediatric subjects without coercion. 4 -6 An additional ethical issue that has not received much attention in the literature is placebo use in pediatric clinical trials. Although guidelines issued by the American Academy of Pediatrics several years ago endorsed the use of placebo in limited circumstances in pediatric clinical trials, 7 these guidelines were issued before the recent increase in pediatric clinical trials, which has greatly increased the numbers of children with chronic illnesses involved in such research.Indeed, the ethics of placebo use in pediatric trials, especially those involving subjects with potentially significant illness, have recently been questioned. 8 Of all of the medications that the FDA has requested be studied in children as a result of the FDAMA, one of the largest categories is cardiovascular medications, particularly antihypertensives. 2 As of March 2003, at least 20 written requests have been issued by the FDA for studies of antihypertensive compounds in children, and manufacturers have responded to these requests with at least 15 pediatric clinical trials. Many of these industry-sponsored studies of antihypertensive agents have incorporated placebo controls to establish efficacy. These studies are being conducted at the same time that some investigators have called for the end of placebo use in adult hypertension research because of the well-known cardiovascular consequences of untreated hypertension in adults. 9 However, placebo use in pediatric antihypertensive trial...

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A single pediatric center experience with 1025 children with hypertension

Cited by 160 publications

References 5 publications

Spontaneously Resolving Hyperreninemic Hypertension Caused by Accessory Renal Artery Stenosis in a 13‐Year‐Old Girl: A Case Report

Spontaneously Resolving Hyperreninemic Hypertension Caused by Accessory Renal Artery Stenosis in a 13‐Year‐Old Girl: A Case Report

Pediatric Hypertension in Two University Hospitals in Cotonou, Benin: Presentation, Etiology, Management and Outcome

Ethics of Placebo Use in Pediatric Clinical Trials

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