Therapeutic Options for the Treatment of Hypertension in Children and Adolescents

Abstract

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%–5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies.

Management of hypertension in children and adolescents

“…1 Like in adults, choice of antihypertensive agents can include ACEIs, angiotensin receptor antagonists, calcium antagonists, beta-blockers and diuretics (Table 2). 1,5,6 Although many individual antihypertensive compounds have been studied in the pediatric age group, no pediatric studies comparing different agents have been conducted. 3,5,6,21 This situation leaves the prescriber without evidence-based guidance for choice of drug.…”

“…16 In very young children (,6 years), hypertension is most often the result of renal parenchymal diseases such as glomerulonephritis, renal scarring, polycystic kidney, renal artery stenosis and renal dysplasia. 1,5 Hypertension is present in approximately 50% of children with chronic kidney disease. 17 Both high BP and increased proteinuria are predictors of the progression of renal disease among children with chronic kidney disease.…”

“…5 While these therapies may be effective in reducing the BP to the targeted levels, pharmacologic therapy will need to be considered if they do not. 5 Life style changes should not only precede but also accompany pharmacological treatment. 1 …”

“…Extensive pediatric normative data on auscultatory clinic measurements have been provided for the United States, based on more than 70 000 children, from the Task Force for Blood Pressure in Children. [5][6][7] A few national studies were undertaken in Europe, but were unable to overrule the Task Force for Blood Pressure 1 as reference, even for the European setting, 8 since they included less patients, and differences were only mild and therefore hardly clinically relevant. Normal BP in children is defined as systolic blood pressure (SBP) and diastolic blood pressure (DBP) less than 90th percentile for age, sex and height, whereas hypertension is defined as SBP and/or DBP persistently 95th percentile or more, measured on at least three separate occasions with the auscultatory method.…”

“…3 Longitudinal studies have made it clear that BP abnormalities during childhood do translate into adult hypertension. [1][2][3][4][5][6] Where there was in the past a predominance of secondary hypertension in children, associated with renal disorders and/or drug therapy, there is now an increasing frequency of essential hypertension. There are two major reference frames for the management of hypertension in children: The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents from the National Heart, Lung and Blood Institute 6 and the revised guidelines of the European Society of Hypertension.…”