Diagnosis, Epidemiology, and Management of Hypertension in Children

Abstract

National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry. Data relating hypertension in childhood to later cardiovascular events is currently lacking. It is known that BP in childhood is highly predictive of BP in adulthood. Compelling data about target organ damage is available, including the association of hypertension with left ventricular hypertrophy, carotid-intima media thickness, and microalbuminuria. Guidelines from both the United States and Europe include detailed recommendations for diagnosis and management. Diagnostic standards are based on clinic readings, ambulatory BP monitoring is useful in confirming diagnosis of hypertension and identifying white-coat hypertension, masked hypertension, and secondary hypertension, as well as monitoring response to therapy. Research priorities include the need for reliable prevalence estimates based on diverse populations and data about the long-term impact of childhood hypertension on cardiovascular morbidity and mortality. Priorities to improve clinical practice include more education among clinicians about diagnosis and management, clinical decision support to aid in diagnosis, and routine use of ambulatory BP monitoring to aid in diagnosis and to monitor response to treatment.

Estado nutricional antropométrico e associação com pressão arterial em crianças e adolescentes: um estudo populacional

“…As associações entre níveis pressóricos aumentados e excesso de peso e de gordura abdominal são pontos importantes para o entendimento da causa da hipertensão em populações jovens. São múltiplas as causas de hipertensão nessa população, porém as mais comuns são o excesso de peso e o excesso de consumo alimentar de sódio [25]. Estes resultados confirmam a necessidade do uso de mais de uma variável antropométrica para distinguir precocemente riscos associados às doenças cardiovasculares.…”

Hypertension in the Pediatric Kidney Transplant Recipient

“…These risk factors include tobacco smoking, illicit drug use, medications for attention deficit hyperactivity disorder, high-salt diet, physical inactivity, obesity, sleep disturbances including obstructive sleep apnea, and genetic determinants of hypertension (55–59). Figure 2 outlines the common etiologies observed for post-transplant hypertension in relation to time after transplant.…”

One Step Further Toward a Targeted Screening Program

“…Far higher prevalence is reported when studies report 1-time measurements. 4 The higher prevalence can be explained with a high rate of false-positives and white coat hypertension, both strong arguments against 1-time screening, the lower rates point to a more complex issue. The primary question is how representative study populations and reference values actually are?…”