Treatment of Pediatric Hypertension
We conducted a MEDLINE search from January 1966-March 1999 to obtain information on clinical trials of treatment of pediatric hypertension. An article was selected for review if it described a randomized or nonrandomized study; randomized studies were given priority. Case reports were considered when studies were unavailable. Review articles were useful in identifying references. According to data we collected, hypertension is present in 1-3% of the pediatric population. Nonpharmacologic treatment may be effective initially in those with mild to moderate disease or as an adjunct to drug therapy. Drugs for treatment of chronic hypertension include calcium channel blockers, angiotensin-converting enzyme inhibitors, diuretics, and ß-blockers. Patient and drug characteristics determine therapy. Intravenous labetalol, nicardipine, and nitroprusside are effective for treating hypertensive emergencies.
During the 1980s the focus of blood pressure measurement in children was to detect hypertension due to secondary causes. Today, blood pressure is measured routinely to detect hypertension in asymptomatic children. Increased monitoring indicated that mild elevations of blood pressure are more common in these patients than previously thought (1-3%).
The prevalence of the disease varies according to age, body weight, and genetic background. The frequency in healthy newborns is about 0.2%; it increases to about 1% in the first decade of life and even more in adolescence. Adolescents are most likely to have primary hypertension. Some children in the first decade of life may have primary hypertension, although they are more likely to have secondary hypertension.
Reference standards for blood pressure measurement in children do not distinguish between race and ethnicity. Although earlier studies found significant differences between Asians and other racial groups, the differences now are thought to be clinically insignificant. Studies between gender are controversial, and differences detected in some of them are considered insignificant.
Body size is the major determinant of children's blood pressure. A direct correlation with increasing body weight was found in children as young as 5 years, and hypertension in obese children becomes prominent during adolescence. The most recent guidelines for treatment of pediatric hypertension incorporated height measurement into the classifications to allow for differences in growth rates and to avoid misclassifying children at the extremes of normal growth.
Heredity is implicated in primary hypertension in both children and adults. When both parents have essential hypertension, the child is at greater risk of developing the disorder. Up to 50% of children with asymptomatic hypertension may have a family history of the disease.
Hypertension in children may or may not have an underlying cause and may vary with age (Table 1). Infants are likely to be affected due to renal artery thrombosis, coarctation of the aorta, or bronchopulmonary dysplasia, whereas in older children the main cause may be renal disease. Symptoms vary depending on the level of blood pressure elevation.
Abstract
We conducted a MEDLINE search from January 1966-March 1999 to obtain information on clinical trials of treatment of pediatric hypertension. An article was selected for review if it described a randomized or nonrandomized study; randomized studies were given priority. Case reports were considered when studies were unavailable. Review articles were useful in identifying references. According to data we collected, hypertension is present in 1-3% of the pediatric population. Nonpharmacologic treatment may be effective initially in those with mild to moderate disease or as an adjunct to drug therapy. Drugs for treatment of chronic hypertension include calcium channel blockers, angiotensin-converting enzyme inhibitors, diuretics, and ß-blockers. Patient and drug characteristics determine therapy. Intravenous labetalol, nicardipine, and nitroprusside are effective for treating hypertensive emergencies.
Introduction
During the 1980s the focus of blood pressure measurement in children was to detect hypertension due to secondary causes. Today, blood pressure is measured routinely to detect hypertension in asymptomatic children. Increased monitoring indicated that mild elevations of blood pressure are more common in these patients than previously thought (1-3%).
The prevalence of the disease varies according to age, body weight, and genetic background. The frequency in healthy newborns is about 0.2%; it increases to about 1% in the first decade of life and even more in adolescence. Adolescents are most likely to have primary hypertension. Some children in the first decade of life may have primary hypertension, although they are more likely to have secondary hypertension.
Reference standards for blood pressure measurement in children do not distinguish between race and ethnicity. Although earlier studies found significant differences between Asians and other racial groups, the differences now are thought to be clinically insignificant. Studies between gender are controversial, and differences detected in some of them are considered insignificant.
Body size is the major determinant of children's blood pressure. A direct correlation with increasing body weight was found in children as young as 5 years, and hypertension in obese children becomes prominent during adolescence. The most recent guidelines for treatment of pediatric hypertension incorporated height measurement into the classifications to allow for differences in growth rates and to avoid misclassifying children at the extremes of normal growth.
Heredity is implicated in primary hypertension in both children and adults. When both parents have essential hypertension, the child is at greater risk of developing the disorder. Up to 50% of children with asymptomatic hypertension may have a family history of the disease.
Hypertension in children may or may not have an underlying cause and may vary with age (Table 1). Infants are likely to be affected due to renal artery thrombosis, coarctation of the aorta, or bronchopulmonary dysplasia, whereas in older children the main cause may be renal disease. Symptoms vary depending on the level of blood pressure elevation.