hypertension in adolescents & children
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Etiology
- also see hypertension
- endocrine
- increased intracranial pressure
- obstructive sleep apnea
- systemic lupus erythematosus
- renal artery stenosis
- coarctation of the aorta[4]
- obesity
Pathology
- higher systolic blood pressure from infancy across the early life is associated with higher carotid intima-media thickness in young adulthood[9]
- contributions to carotid intima-media thickness aremapproximately equal from systolic blood pressure in infancy, preschool childhood, childhood, adolescence, young adulthood into mid-adulthood[9]
Clinical manifestations
- tachycardia: pheochromocytoma, hyperthyroidism
- moon facies: Cushing syndrome glucocorticoid use
- papilledema: increased intracranial pressure
- adenotonsillar hypertrophy: obstructive sleep apnea
- malar rash: systemic lupus erythematosus
- renal bruit: renal artery stenosis
- BP in upper > lower extremities: coarctation of the aorta
Laboratory
Diagnostic procedures
- ambulatory blood pressure monitoring for 24 hours to confirm diagnosis & periodically to monitor therapy[2]
- home BP monitoring should not be used for diagnosis[3]
- lower extremity blood pressure
- rule out coarctation of the aorta[4]
- funduscopy (retinal exam)[1]
- sleep study not routinely recommended for obesity[4]
Radiology
- echocardiography recommended prior to drug therapy[3]
- renal ultrasonography[1]
Staging
- > 130/80 stage 1
- > 140/90 stage 2
Complications
- men with blood pressure > 140/90 mm Hg at age 18 years have higher risk of cardiovascular events by 68 years of age[8]
Management
- first line
- healthy diet (low sodium, high potassium)[1], DASH diet[3]
- regular exercise
- weight reduction
- monitor blood pressure, weight
- antihypertensive agent if 1st line intervention inadequate
- ACE inhibitor 1st line[1]
More general terms
More specific terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Ingelfinger JR The Child or Adolescent with Elevated Blood Pressure N Engl J Med 2014; 370:2316-2325. June 12, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25207779 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1001120
- ↑ 2.0 2.1 Rao G Diagnosis, epidemiology, and management of hypertension in children. Pediatrics 2016 Jul 12. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27405770
- ↑ 3.0 3.1 3.2 3.3 Stapleton FD AAP Updates Guidelines for Pediatric Hypertension. NEJM Journal Watch. Aug 21, 2017 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
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 Aug 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28827377 - ↑ 4.0 4.1 4.2 4.3 NEJM Knowledge+ Question of the Week. Hune 12, 2018 https://knowledgeplus.nejm.org/question-of-week/4893/
- ↑ 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 Sep;140(3). pii: e20171904. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28827377
- ↑ Weaver DJ. Hypertension in children and adolescents. Pediatr Rev 2017 Aug; 38:369. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28765199
- ↑ Moyer VA et al. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Pediatrics 2013 Nov; 132:907-914. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24101758 Free Article
- ↑ 8.0 8.1 Rietz H et al. Blood pressure level in late adolescence and risk for cardiovascular events: A cohort study. Ann Intern Med 2023 Sep 26; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/37748182 https://www.acpjournals.org/doi/10.7326/M23-0112
- ↑ 9.0 9.1 9.2 Meng Y, Sharman JE, Koskinen JS et al Blood Pressure at Different Life Stages Over the Early Life Course and Intima-Media Thickness. JAMA Pediatr. Published online December 4, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38048127 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2812150