Management of the hypertensive child

Abstract

Hypertension (HTN) is a major risk factor for cardiovascular disease which is the leading cause of morbidity and mortality in adults in the USA [1]. Over the last two decades, there has been an alarming increase in the incidence of childhood HTN which has been principally linked to the “obesity epidemic” [2–4]. HTN in children is on the rise and currently affects 3–4 % of children and adolescents [3, 5, 6]. Pre-HTN is even more prevalent and affects 10–15 % of youths [5, 6]. Thus, it is incumbent on all pediatricians to be well aware of this important disorder and to become more familiar with its diagnosis, evaluation, and management. Rise in pediatric HTN raises great concern that the early onset of HTN during childhood may accelerate the occurrence of cardiovascular disease during early adulthood. Therefore, a lot of emphasis has been placed on the prevention or management of obesity. This approach has been especially useful in adults in whom the simultaneous application of several non-pharmacologic interventions to prevent and co-manage HTN such as weight loss, diet and exercise, are at least equivalent in efficacy to drug monotherapy [7–10]. These interventions are also important in managing childhood HTN. However, despite the heightened awareness and attention focused on prevention and management of obesity in youth, a new survey showed no significant change in the prevalence of this condition over the past 8 years [11]. These disappointing data underscore the need for new strategies to identify and manage the root causes of obesity in children. In our view, there are multiple old and new socioeconomic, psychobehavioral, and cultural trends that not only underlie the development of obesity but also trigger other mechanisms that tend to raise blood pressure (BP). Many of these aspects have been largely underappreciated and are often ignored in strategies designed to prevent or attenuate HTN. A greater understanding of these newer contributors of HTN offers the possibility of an even greater potential benefit derived from non-pharmacologic interventions in all children with elevated BP. Thus, in the current chapter we have greatly expanded the non-pharmacologic section for management of childhood HTN, bringing attention to several additional novel factors other than overeating and lack of exercise, which contribute to obesity and HTN.