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Sustained hypertension in children
P Hari1, A Bagga, R N Srivastava
1Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India.
Insights
Most children with sustained hypertension have an identifiable cause, often kidney-related. Some patients with renovascular or endocrine issues may first present with severe hypertension complications.
Area of Science:
- Pediatric Nephrology
- Pediatric Cardiology
- Internal Medicine
Background:
- Sustained hypertension in children is a significant clinical concern.
- Identifying the underlying etiology is crucial for effective management.
Purpose of the Study:
- To investigate the causes and clinical characteristics of sustained hypertension in a pediatric population.
- To understand the presentation patterns of pediatric hypertension.
Main Methods:
- Retrospective hospital-based study.
- Analysis of 246 children with sustained hypertension (1983-1996).
- Data collection on age, sex, etiology, and presenting symptoms.
Main Results:
- The mean age of presentation was 8.2 years; 180 out of 246 patients were boys.
- An underlying cause was identified in 98.4% of cases, with chronic glomerulonephritis being the most common (49.2%).
- Renovascular disease, including Takayasu's disease, and coarctation of the aorta were significant causes, particularly in infants. 80.5% had hypertension as a feature of a known disease, while some presented with severe complications like cardiac failure or encephalopathy.
Conclusions:
- The majority of pediatric sustained hypertension cases have a specific underlying etiology.
- Renovascular and endocrine conditions can lead to initial presentations with severe hypertensive complications.
Objective:
To study the etiology and clinical profile of children with sustained hypertension.
Design:
Retrospective hospital-based study.
Setting:
Tertiary care, referral center.
Subjects:
246 children with sustained hypertension presenting between January 1983 and December 1996.
Results:
The mean age at presentation was 8.2+/-3.9 yr; range 2 months-16 yr. There were 180 boys. An underlying cause for hypertension was identified in 242 (98.4%); 4 patients were considered to have essential hypertension. The chief causes included chronic glomerulonephritis (GN) in 121 (49.2%), obstructive uropathy in 39 (15.8%), reflux nephropathy in 30 (12.2%), thrombotic microangiopathy in 15 (6.1%) and renovascular disease in 14 (5.7%). Takayasu's disease was the most common cause of renovascular hypertension. Coarctation of aorta was the commonest cause of hypertension in infancy, being present in 53.3% of cases. In 198 subjects (80.5%) hypertension was detected as a feature of a known underlying disease. Thirty-five patients however, presented for the first time with complications of severe hypertension, including congestive cardiac failure in 21 and encephalopathy in 23. Thirteen patients presented with nonspecific symptoms and hypertension was detected on clinical examination.
Conclusions:
Most patients with sustained hypertension have an underlying etiology. A significant proportion of patients with renovascular and endocrine conditions may present, for the first time, with complications of hypertension.