Evaluation of hypertension in childhood diseases

Abstract

Evaluation of hypertension in the pediatric age group should be guided by the age at presentation, the severity of hypertension at presentation, and whether the hypertension is sustained or transient. The common causes of hypertension differ by age group (Table 1). Hypertension is more likely to be secondary and sustained in the younger age groups, whereas primary (essential) hypertension and white coat hypertension are more likely to be the etiology in adolescents [1–5]. The global epidemic of childhood obesity has been associated with an increased incidence of primary hypertension and prehypertension in adolescents worldwide [3–7]. Obese children have as much as a threefold higher risk for developing hypertension compared to nonobese children [7]. The frequent occurrence of primary hypertension in obese adolescents dictates an entirely different evaluation than for younger or nonobese children. Renal disease must be considered in every child with hypertension, because of the prevalence of renovascular and renal parenchymal disorders as the etiology in any age group. Secondary hypertension from renal disorders is more likely to be severe at presentation than primary hypertension. Endocrine causes of hypertension are rare, so special diagnostic studies for these disorders should be reserved for those patients whose history, physical examination, and preliminary evaluation warrant further specific investigation. This chapter outlines the steps in evaluation of childhood hypertension, starting with the confirmation of the diagnosis and evaluation of its duration and severity.