Prediction of Primary vs Secondary Hypertension in Children

Baracco, Rossana; Kapur, Gaurav; Mattoo, Tej K.; Jain, Amrish; Valentini, Rudolph P.; Ahmed, Maheen; Thomas, Ronald

doi:10.1111/j.1751-7176.2012.00603.x

Cited by 69 publications

(47 citation statements)

References 31 publications

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“…[7,8] This is consistent with prior research suggesting primary care pediatricians are uncomfortable in treating and managing pediatric hypertension. [10,11] However, the “refer all” approach is unlikely to be sustainable by pediatric cardiology or pediatric nephrology workforce, and it is a source of frustration for some pediatric hypertension specialists.…”

Section: Introductionsupporting

confidence: 83%

Pediatric Hypertension Specialists’ Perspectives About Adolescent Hypertension Management

Yoon

McCool

Filipp

et al. 2014

Clin Pediatr (Phila)

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Background The current specialty-centric hypertension paradigm is unsustainable given the high prevalence of primary hypertension in adolescents. Objective To describe specialists’ perspectives on referral and comanagement for adolescents with hypertension. Methods Cross-sectional mailed survey of a national sample of 397 pediatric cardiologists and 389 pediatric nephrologists, conducted January to May 2014. Results Response rate was 61%. Both specialties agreed that primary care providers can make the hypertension diagnosis, try lifestyle changes, and comanage monitoring of patient blood pressure control and medication side effects, but they felt antihypertensive medication use should mainly occur in the specialty setting. Conclusions Our study suggests specialist support for changing the hypertension paradigm to encourage primary care providers, in collaboration with specialists, to diagnose hypertension, initiate lifestyle changes, and monitor progress and side effects. Future work should focus on supporting primary care physician comanagement of adolescents with hypertension.

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Section: Introductionsupporting

confidence: 83%

Pediatric Hypertension Specialists’ Perspectives About Adolescent Hypertension Management

Yoon

McCool

Filipp

et al. 2014

Clin Pediatr (Phila)

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“…However, a direct correlation between hypertensive encephalopathy and renal disease has not been proven. Unlike other etiologies, hypertension originating from renal disease could cause severe hypertension by complex mechanisms, such as renin angiotensin system activation, fluid overload, activated sympathetic tone, and an electrolyte imbalance15,16). This study showed that the renal origin hypertension group had higher mean blood pressure than the nonrenal origin hypertension.…”

Section: Discussionmentioning

confidence: 63%

Clinical characteristics of hypertensive encephalopathy in pediatric patients

et al. 2017

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PurposeThe aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children.MethodsWe retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renal-origin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups.ResultsThe renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group (172.5±36.9 mmHg) was higher than that of the nonrenal group (137.1±11.1 mmHg, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05).ConclusionWe conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non-renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI.

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“…Secondary hypertension is more common in younger children resulting from reno-vascular or renal parenchymal disease (78–80% of causes) (14, 15), endocrine (11% of causes) (14), cardiac (2% of causes) (16), pulmonary and others as shown in Table 1. Since PCCs and PGLs account for only 0.5–2% (2) of secondary hypertension, one should be mindful to rule out more common causes when evaluating a child with elevated blood pressure (BP).…”

Section: Causes Of Hypertension In Pediatricsmentioning

confidence: 99%

Review of Pediatric Pheochromocytoma and Paraganglioma

2017

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Pheochromocytoma (PCC) and paraganglioma (PGL) are rare chromaffin cell tumors which secrete catecholamines and form part of the family of neuroendocrine tumors. Although a rare cause of secondary hypertension in pediatrics, the presentation of hypertension in these patients is characteristic, and treatment is definitive. The gold standard for diagnosis is via measurement of plasma free metanephrines, with imaging studies performed for localization, identification of metastatic lesions and for surgical resection. Preoperative therapy with alpha-blocking agents, beta blockers, and potentially tyrosine hydroxylase inhibitors aid in a safe pre-, intra- and postoperative course. PCC and PGL are inherited in as much as 80% of pediatric cases, and all patients with mutations should be followed closely given the risk of recurrence and malignancy. While the presentation of chromaffin cell tumors has been well described with multiple endocrine neoplasia, NF1, and Von Hippel–Lindau syndromes, the identification of new gene mutations leading to chromaffin cell tumors at a young age is changing the landscape of how clinicians approach such cases. The paraganglioma–pheochromocytoma syndromes (SDHx) comprise familial gene mutations, of which the SDHB gene mutation carries a high rate of malignancy. Since the inheritance rate of such tumors is higher than previously described, genetic screening is recommended in all patients, and lifelong follow-up for recurrent tumors is a must. A multidisciplinary team approach allows for optimal health-care delivery in such children. This review serves to provide an overview of pediatric PCC and PGL, including updates on the preferred methods of imaging, guidelines on gene testing as well as management of hypertension in such patients.

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Prediction of Primary vs Secondary Hypertension in Children

Cited by 69 publications

References 31 publications

Pediatric Hypertension Specialists’ Perspectives About Adolescent Hypertension Management

Pediatric Hypertension Specialists’ Perspectives About Adolescent Hypertension Management

Clinical characteristics of hypertensive encephalopathy in pediatric patients

Review of Pediatric Pheochromocytoma and Paraganglioma

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