Hypertension is estimated to affect
more than 50 million Americans and is one of the leading causes
of cardiovascular disease, end-stage renal disease, and cerebrovascular
accidents.Although hypertension and associated end-organ damage occur
more commonly in adults, hypertension and its resultant complications
do occur in childhood.Most affected children have underlying cardiorenal disease
resulting in secondary forms of hypertension.However, idiopathic or essential hypertension, for which
no identifiable cause is found, clearly can begin in childhood.Many challenges remain in the study of pediatric hypertension.It is known that children who have high blood pressure tend
to be hypertensive as adults. It remains to be definitively determined
what level of blood pressure predicts hypertensive end-organ injury.
Our faculty from the IPHA-sponsored hypertension course at the September 2011 ESPN meeting
Pictured from left to right: M Litwin, E Urbina, J Flynn, A Zurowska and T Seeman
2011 AHA (November 13) Cardiovascular Risk Reduction in Children and Adolescents: The new NHLBI Guideline
2012 IPHA General Member Meeting (April 30, 2012, 6pm)
2012 PAS (April 28, 2012 - May 1, 2012)
2012 ASH (May 19, 2012 - May 22, 2012) 2012 ESPN (September 6, 2012 - September 9, 2012)
As many as 5% of children and
adolescents may have essential hypertension – up to
11% in a minority population. In Houston, Texas that means
there may be up to 50,000 hypertensive children.
The effects of hypertension can begin during
childhood. Mild to moderate hypertension is most commonly
asymptomatic but may be associated with subtle changes in
behavior or school performance.
Hypertensive children tend to have other
medical problems, such as obesity, high blood lipids and/or
diabetes mellitus.
Clinic measurements are frequently unreliable
for assessing a patient’s hypertensive status. 24-hour
(ABPM) ambulatory blood pressure monitorings allow for a more
comprehensive blood pressure assessment.
Hypertension can present with many different
24-hour blood pressure patterns including white coat, nocturnal,
diurnal, high amplitude, and stress-induced hypertension.
Children and adolescents should have their
blood pressure measured at least once per year.
When your patient has blood
pressure values greater then 95th percentile for gender, age,
and height on three different occasions.
When your patient has blood pressure values
greater than the 90th percentile for gender, age, and height
on three different occasions and has one or more risk factors
of cardiovascular disease (e.g. obesity, diabetes mellitus,
high blood lipids and / or family history of stroke, coronary
heart disease or its risk factors).
When your patient's blood pressure values
in the clinic are inconsistent with blood pressure measurements
in other settings.
When a patient with a confirmed diagnosis
of hypertension has failed non-pharmacological management.
When documentation of blood pressure control
by anti-hypertensive medication is required.
When comprehensive management with the latest
anti-hypertensives, exercise, weight loss, and dietary support
is indicated.
