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*Children and adolescents with severe hypertension are at risk of developing hypertensive encephalopathy, seizures, cerebrovascular accidents, and congestive heart failure.<ref name="pmid16719248">{{cite journal| author=Luma GB, Spiotta RT| title=Hypertension in children and adolescents. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 9 | pages= 1558-68 | pmid=16719248 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16719248  }} </ref>
*Children and adolescents with severe hypertension are at risk of developing hypertensive encephalopathy, seizures, cerebrovascular accidents, and congestive heart failure.<ref name="pmid16719248">{{cite journal| author=Luma GB, Spiotta RT| title=Hypertension in children and adolescents. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 9 | pages= 1558-68 | pmid=16719248 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16719248  }} </ref>


==[[Diagnosis]]==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===



Revision as of 20:21, 14 June 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dinesh Shah, M.B.B.S, José Eduardo Riceto Loyola Junior, M.D.[2]

Synonyms and keywords:

Overview

Hypertension is one of the major risk factor for cardiovascular diseases. It is often associated with adverse cardiac and vascular outcomes. Hypertension in pediatric age group often leads to development of cardiovascular compromises for the patient, such as atherosclerotic plaques development and renal function loss in the adulthood. To make matters worse, pediatric hypertension is greatly underdiagnosed due to difficulty in measurement of blood pressure in children and the need to refer to detailed tables of normative values. Thus, cautious monitoring, early diagnosis and treatment of hypertension in children is critical to prevent disease progression.

Classification

Pediatric hypertension may be classified according to AAP (American Academic of Pediatrics):[1]

Age<13 years Age>=13 years

Normal Blood pressure

<90th percentile

<180/<90 mmhg

Elevated or High Normal Blood Pressure

90th to <95th percentile

120-129/<80 mmHg

Stage 1 Hypertension

>95th percentile to <95th percentile +12 mmHg

130-139/80-89 mmHg

Stage 2 Hypertension

>95th percentile + 12 mmHg

>140/90 mmHg

Pathophysiology

Causes

Based on etiology, hypertension in children can be classified into 2 groups:[3]

  • 1. Primary hypertension - No specific cause known
  • 2. Secondary hypertension - Common causes includes:[4]

Common causes of pediatric hypertension by pediatric age group

These conditions are displayed in order of prevalence[6][7][8]

One to six years:

Six to twelve years:

Twelve to eighteen years

Differentiating Hypertension in Adolescents from other Diseases

Hypertension in adolescent may be a symptom of other underlying and undiagnosed conditions. Thus, these patients require a detailed medical assessment. Secondary causes were discussed above and include: renal diseases, drugs, adrenal diseases and hyperthyroidism.

Epidemiology and Demographics

Risk Factors

Screening

  • According to the U.S. Preventive Services Task Force (USPSTF), screening for hypertension in asymptomatic children and adolescents is not recommended.[12]
  • According to the 2017 American Academy of Pediatrics guidelines, screening for hypertension in asymptomatic children and adolescents is recommended annually beginning at three years of age.[12]
  • According to the 2016 European Society of Hypertension guidelines, screening for hypertension in asymptomatic children and adolescents is recommended every two years beginning at three years of age.[12]

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

  • The diagnostic study of choice for diagnosing hypertension in adolescents is the attainment of accurate blood pressure measurement in children and adolescents.
  • It can be challenging due to the variance of the measurements with different cuff sizes, anxiety, patient positioning, caffeine intake, and activity levels.
  • To choose an adequate cuff size, one must pick an inflatable bladder that is at least 40% of the arm circumference and bladder length that is 80% to 100% of the arm circumference.[12]

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

  • There are no CT scan findings diagnostic of hypertension.
  • It can diagnose some causes of hypertension such as coarctation of aorta or adrenal disease.

MRI

  • There are no CT scan findings diagnostic of hypertension.
  • It can diagnose some causes of hypertension such as coarctation of aorta or adrenal disease.

Other Imaging Findings

  • There are no other imaging findings associated with hypertension.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with hypertension.

Treatment

The AAP guideline recommends keeping systolic and diastolic pressure under 90th percentile or <130/80 mmHg in patients aged 13 or older to prevent any cardiovascular events.

Medical Therapy

Lifestyle modifications

  • All children and adolescent with hypertension should change their lifestyle for the better.[12]
  • Such changes include: weight reduction if obese or overweight, regular physical activity, healthy diet (DASH diet), avoidance of substance use, stress reduction, family-based interventions (involving the whole family on such lifestyle changes can dramatically increase therapeutic adherence).[12]

Pharmacological treatment

Surgery

Surgery is not the first-line treatment option for children with hypertension. Surgery is usually reserved for children with select adrenal disease or coarctation of aorta.

Primary prevention

Effective measures for the primary prevention of primary hypertension in children include low sodium intake, adhering to the DASH diet, maintaining appropriate body weight, and regular physical activities.

Secondary prevention

There are no established measures for the secondary prevention of hypertension in children.

References

  1. Weaver DJ (2019). "Pediatric Hypertension: Review of Updated Guidelines". Pediatr Rev. 40 (7): 354–358. doi:10.1542/pir.2018-0014. PMID 31263043.
  2. Raj M, Krishnakumar R (2013). "Hypertension in children and adolescents: epidemiology and pathogenesis". Indian J Pediatr. 80 Suppl 1: S71–6. doi:10.1007/s12098-012-0851-4. PMID 22941155.
  3. Khoury, M. and Urbina, E. M. (2021) ‘Hypertension in adolescents: diagnosis, treatment, and implications’, The Lancet Child & Adolescent Health, 5(5), pp. 357–366. doi: 10.1016/S2352-4642(20)30344-8
  4. Friedman K, Wallis T, Maloney KW, et al. An unusual cause of pediatric hypertension. J Pediatr 2007; 151:206.
  5. Marcus CL, Greene MG, Carroll JL. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med 1998; 157:1098
  6. Flynn JT (2001). "Evaluation and management of hypertension in childhood". Prog Pediatr Cardiol. 12 (2): 177–188. doi:10.1016/s1058-9813(00)00071-0. PMID 11223345.
  7. Bartosh SM, Aronson AJ (1999). "Childhood hypertension. An update on etiology, diagnosis, and treatment". Pediatr Clin North Am. 46 (2): 235–52. doi:10.1016/s0031-3955(05)70115-2. PMID 10218072.
  8. Flynn JT (2005). "Hypertension in adolescents". Adolesc Med Clin. 16 (1): 11–29. doi:10.1016/j.admecli.2004.10.002. PMID 15844381.
  9. 9.0 9.1 Bell CS, Samuel JP, Samuels JA (2019). "Prevalence of Hypertension in Children". Hypertension. 73 (1): 148–152. doi:10.1161/HYPERTENSIONAHA.118.11673. PMC 6291260. PMID 30571555.
  10. 10.0 10.1 Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K; et al. (2019). "Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis". JAMA Pediatr. 173 (12): 1154–1163. doi:10.1001/jamapediatrics.2019.3310. PMC 6784751 Check |pmc= value (help). PMID 31589252.
  11. 11.0 11.1 Ewald DR, Haldeman PhD LA (2016). "Risk Factors in Adolescent Hypertension". Glob Pediatr Health. 3: 2333794X15625159. doi:10.1177/2333794X15625159. PMC 4784559. PMID 27335997.
  12. 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 12.10 Riley M, Hernandez AK, Kuznia AL (2018). "High Blood Pressure in Children and Adolescents". Am Fam Physician. 98 (8): 486–494. PMID 30277729.
  13. Luma GB, Spiotta RT (2006). "Hypertension in children and adolescents". Am Fam Physician. 73 (9): 1558–68. PMID 16719248.
  14. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140.
  15. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140.
  16. Chhadia S, Cohn RA, Vural G, Donaldson JS. Renal Doppler evaluation in the child with hypertension: a reasonable screening discriminator? Pediatr Radiol 2013; 43:1549..
  17. Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 2016; 34: 1887–920.


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