Primary Pediatric Hypertension: Current Understanding and Emerging Concepts

Abstract

The rising prevalence of primary pediatric hypertension and its tracking into adult hypertension point to the importance of determining its pathogenesis to gain insights into its current and emerging management. Considering that the intricate control of BP is governed by a myriad of anatomical, molecular biological, biochemical, and physiological systems, multiple genes are likely to influence an individual's BP and susceptibility to develop hypertension. The long-term regulation of BP rests on renal and non-renal mechanisms. One renal mechanism relates to sodium transport. The impaired renal sodium handling in primary hypertension and salt sensitivity may be caused by aberrant counter-regulatory natriuretic and anti-natriuretic pathways. The sympathetic nervous and renin-angiotensin-aldosterone systems are examples of antinatriuretic pathways. An important counter-regulatory natriuretic pathway is afforded by the renal autocrine/paracrine dopamine system, aberrations of which are involved in the pathogenesis of hypertension, including that associated with obesity. We present updates on the complex interactions of these two systems with dietary salt intake in relation to obesity, insulin resistance, inflammation, and oxidative stress. We review how insults during pregnancy such as maternal and paternal malnutrition, glucocorticoid exposure, infection, placental insufficiency, and treatments during the neonatal period have long-lasting effects in the regulation of renal function and BP. Moreover, these effects have sex differences. There is a need for early diagnosis, frequent monitoring, and timely management due to increasing evidence of premature target organ damage. Large controlled studies are needed to evaluate the long-term consequences of the treatment of elevated BP during childhood, especially to establish the validity of the current definition and treatment of pediatric hypertension.

Vitamin D status and blood pressure in children and adolescents: a systematic review of observational studies

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“…Hypertension, or elevated blood pressure (BP), is a well-recognized risk factor for both cardiovascular and renal diseases in addition to a vast array of diseases contributing significantly to Nutrients 2020, 12, 1163 2 of 17 mortality [8,9]. Specifically, childhood hypertension poses a considerable public health challenge [10], and is associated with essential hypertension in adults and detrimental cardiovascular events [9,11]. Recent pooled estimates suggest the global prevalence of childhood hypertension has reached 4%, and that it is generally more common in adolescents undergoing puberty and children who are overweight or obese.…”

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“…Figure 1. Factors interacting in the pathogenesis of arterial hypertension at different stages of life (modified from[23]). RAAS: renin angiotensin aldosterone system.…”