Hypertension
last authored:
last reviewed:
Introduction
Should start screening children under age 3.
Over 90th percentile - prehypertension; over 95th percentile - hypertension. Need three abnormal readings under normal conditions.
Use the right size blood pressure cuff.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Newborn
- renal artery thrombosis
- renal artery stenosis
- congenital renal abnormalities
- coarctation of the aorta
<10 years
- renal parenchymal disease
- primary (essential) hypertension
- coarctation of the aorta
- renal vascular disease
- endocrine (thyroid, Cushing's)
- malignancies (neuroblastoma, phaeochromocytoma)
>10 years
- primary hypertension (especially with obesity, family history)
medications
- corticosteroids, sympathomimetics, OCP
Pathophysiology
Signs and Symptoms
- history
- physical exam
- lab investigations
- diagnostic imaging
History
- Neonatal history (umbilcal catherization)
- urinary symptoms (hematuria, frequent UTI)
- family history
- medications
Physical Exam
BMI
Four limb blood pressure
Brachio-femoral delay
Murmur
signs of endocrine disease
dysmorphic features suggesting syndrome
Lab Investigations
Guided by clinical exam
- CBC, lytes, renal function
- urinalysis
- endocrine testing: renin, catecholamines
- cholesterol/triglycerides
- fasting blood glucose
Diagnostic Imaging
Guided by clinical exam
- echocardiogram
CXR, EKG
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Treat secondary causes.
Nutrition and activity modification.
Refer to physician experienced in treating pediatric hypertension
- CCBs and ACE inhibitors most common
Consequences and Course
Resources and References
http://www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.pdf
Topic Development
authors:
reviewers:
 |