Hypertension in children from a nephrological perspective — are there any differences between younger children and adolescents?

Abstract

Background. Hypertension (HTN) affects about 5% of children. Renal diseases are the major cause of HTN in pediatric patients, but the incidence of primary HTN is increasing. The aim of the study was to analyze the potential differences between etiology of HTN, type of renal disease leading to HTN, clinical picture, laboratory test results or family history, with reference to patients' age. Material and methods. Medical records of 112 patients (27 children < 11 years and 85 adolescents > 11 years), diagnosed with hypertension in the Department of Pediatric Nephrology, were analyzed. Family history, aetiology of HTN, clinical course and laboratory results were compared, regarding the patients' age. Results. HTN secondary to renal disease prevailed over the primary one in younger children. Major causes of renal HTN differed with age. In children under 11 anomalies in the urinary tract were dominant, in teenagers-glomerulopathies. In adolescents, the incidence of primary HTN was higher than in the younger patients and became comparable to that of secondary HTN. Patients with primary HTN, irrespective of their age, had higher BMI and more frequent positive family history of HTN. Clinical symptoms, except for headaches prevalent in adolescents, did not depend on age. Conclusions. In paediatric patients, hypertension secondary to renal diseases is more frequent than the primary one. The incidence of primary HTN is increasing with age and occurs in adolescents more often than in younger children. The clinical course is usually asymptomatic and may delay the diagnosis, especially in the youngest patients.

Does This Child With High Blood Pressure Have Secondary Hypertension?

“…In the 24 studies that defined the specific etiology for each case of secondary hypertension, 77% of secondary cases were due to kidney or renovascular disease (eTable 3 in the Supplement). Three studies included children and adolescents with primary hypertension and secondary hypertension due to kidney disease, but excluded children and adolescents with causes of secondary hypertension not related to kidney disease . There was 1 study with level 1 evidence, 3 studies with level 2 evidence, 19 studies with level 3 evidence, and 7 studies with level 4 evidence (eTable 2 in the Supplement).…”

“…The individual study methods, study populations, inclusion and exclusion criteria, and proportions of children and adolescents with secondary hypertension are described in eTable 2 in the Supplement. Most studies 4,5,[15][16][17][18][19][20][21]23,[35][36][37][38][39][40][41][42] were retrospective cohorts of consecutive children and adolescents referred to pediatric nephrology or pediatric hypertension clinics. Five studies [43][44][45][46][47] were retrospective cohorts of children and adolescents who had 24-hour ambulatory blood pressure monitoring.…”

“…Three studies included children and adolescents with primary hypertension and secondary hypertension due to kidney disease, but excluded children and adolescents with causes of secondary hypertension not related to kidney disease. 40,41,51 There was 1 study with level 1 evidence, 3 studies with level 2 evidence, 19 studies with level 3 evidence, and 7 studies with level 4 evidence (eTable 2 in the Supplement). The results of the quality assessment of individual studies appear in eFigure 1 in the Supplement and are summarized across all included studies in eFigure 2 in the Supplement.…”