[Arterial hypertension in childhood and adolescence]

The importance of hypertension in the pediatric population is not as well-appreciated as in adults. This might well be related in part to the lower prevalence of high blood pressure in this age group. As with height and weight, blood pressure increases with age during childhood. 'High normal' blood pressure is a blood pressure above the 90th percentile and established hypertension a blood pressure above 95th percentile. The varying arm and thigh sizes of children and adolescents require blood pressure cuffs that are appropriately sized. A cuff that is too small will produce an artificially elevated blood pressure, while a cuff that is too large is not likely to obscure hypertensive levels of blood pressure. The use of an oscillometric device is more convenient for infants. The underlying causes of significant hypertension in the pediatric population differ considerably from those of adults: while the prevalence of hypertension in pediatrics is lower than in adults, clinically identifiable causes of hypertension account for a much higher proportion of hypertension in children. Children with chronic secondary hypertension will require drug therapy with converting-enzyme inhibitors, calcium-channel blockers, beta-blockers or diuretics. Therapy now tends to be initiated with converting-enzyme inhibitors because they are generally effective and have few side effects. Persistent cough sometimes develops on converting enzyme inhibitors. The term sartans denotes a new group of orally active antagonists of the angiotensin II receptor. Since sartans do not cause cough, these agents represent a promising treatment for patients who develop cough with converting enzyme inhibitors.