Hypertension
Hypertension in Children and Adolescents— Diagnostic Challenges and Management
Deborah Lipszyc, MScOT, BSc1 and Rulan S Parekh, MD, MS, FRCP2
1. Research Student, Institute of Medical Science, University of Toronto and Hospital for Sick Children, Toronto; 2. Associate Professor, University of Toronto and Hospital for Sick Children, Toronto
Abstract
The incidence of primary hypertension in children and adolescents is increasing. If not promptly recognized and treated, pediatric hypertension can lead to significant morbidity and mortality later in life. There are, however, numerous challenges clinicians face when diagnosing hypertension, differentiating between primary and secondary hypertension, and treating hypertension in children. New developments in the screening and management of high blood pressure in children must be considered to achieve target goals. These target goals include a blood pressure below the 90th percentile through lifestyle modifications—including a decreased sodium intake, weight reduction and increased physical activity—and, if there is no improvement, the use of medications. It is widely known that high blood pressure carries over into adulthood and the adoption of a lifelong healthy lifestyle is therefore essential.
Keywords Adolescent, child, diagnosis, hypertension, management, pediatric, primary hypertension
Disclosure: The authors have no conflicts of interest to declare. Received: July 29, 2011 Accepted: August 31, 2011 Citation: US Nephrology, 2011;6(2):110–5 Correspondence: Rulan S Parekh, MD, MS, FRCP, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. E:
rulan.parekh@
sickkids.ca
The incidence of primary hypertension is estimated to be 1–20 % and rising among children and young adults, based on national surveys in the US and worldwide (see Table 1).1,2
of 15,702 young adults aged 24–32 years found 19 % of them to have high blood pressure.3
of processed foods—containing additives such as fructose.6,7 For example, a recent study The exact numbers of children with hypertension
worldwide are variable due to the methods used to ascertain prevalence estimates. The World Health Organization (WHO) states that hypertension, cardiovascular disease, and diabetes are the most common non-communicable diseases in developing countries. As life expectancy improves in developing countries, chronic conditions such as hypertension will become increasingly important to screen for among children.
In the US, there are higher rates of hypertension among African-American and Mexican-American children compared with their white counterparts.4 The ethnic differences are striking when accounting for rates of obesity.4,5 These ethnic differences in hypertension could account for the increased rates of cardiovascular risk seen in these communities. Thus, early screening for elevated blood pressure in children and among those with a high risk of hypertension and cardiovascular disease is vital. Obesity is purported to be the most likely reason for the rising rates of hypertension in children and, like hypertension, the prevalence of obesity is increasing worldwide. There are other factors that also account for the rising hypertension rates in children, such as the lack of healthy lifestyle—with more sedentary activities—and the consumption
110
Diagnostic Challenges in Pediatric Hypertension If not promptly recognized and treated, pediatric hypertension can lead to significant morbidity and mortality as children age. Early diagnosis may prevent long-term cardiovascular sequela such as left ventricular hypertrophy, increased intima media thickness, decreased arterial compliance, atherosclerosis, and diastolic dysfunction.2,10–12
Guidelines
by the WHO, the American Academy of Pediatrics, the US National Institute of Health, and the European Society of Hypertension recommend that all children aged three or older should have their blood pressure measured at least once during every medical visit.1,8,13,14
Clinicians must be able to identify children and adolescents with hypertension, but they are confronted with many challenges, one of them being that primary hypertension in children is often asymptomatic. Often, less than 26 % of children are recognized as having elevated blood pressure.10
Also, many children suffering from hypertension are unaware that they will carry a significant cardiovascular risk when they reach young adulthood.3
identified as hypertensive,10
The older, taller and obese children are more likely to be whereas those with unremarkable findings
and without a family history of cardiovascular disease are less likely to be © TOUCH BRIEFINGS 2011
Additionally,
biologic factors, such as increased rates of dyslipidemia, low birthweight, elevated uric acid, and low vitamin D, are also risk factors leading to the development of hypertension.8,9
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84