Hypertension In Children

Paediatric blood pressure must be interpreted according to age, sex and height percentile in younger children. Adolescents increasingly use adult style thresholds in contemporary guidelines.

Secondary hypertension is substantially more common in children than adults, particularly in younger children.

Renal parenchymal and renovascular disease are major causes.

Most children are asymptomatic.

Severe hypertension may cause:

• Headache
• Vomiting
• Visual disturbance
• Seizures
• Altered consciousness
• Heart failure

Use an appropriately sized cuff.

Confirm elevated readings on repeated measurements unless hypertensive emergency is present.

Investigations may include:

• Urinalysis
• Urea, creatinine and electrolytes
• Renal ultrasound
• Lipid profile
• Glucose or HbA1c
• Echocardiography where chronic hypertension is established

Further endocrine or renovascular investigation is guided by presentation.

Lifestyle intervention is appropriate for uncomplicated primary hypertension.

Secondary hypertension requires treatment of the underlying disease.

Common pharmacological options include ACE inhibitors, ARBs, calcium channel blockers and thiazide diuretics.

Amlodipine may be started at approximately 0.05 to 0.1 mg/kg PO once daily, titrated according to response, generally to a maximum of 10 mg/day.

Hypertensive emergency requires ICU level controlled BP reduction. Blood pressure should not be normalized abruptly because excessive rapid reduction can compromise cerebral and renal perfusion.