[Renovascular hypertension in childhood]

Renovascular hypertension constitutes a small percentage of cases of secondary hypertension in childhood. It has to be diagnosed because it is potentially curable. The definition of hypertension in France is based on a study involving 17067 children which analysed the normal distribution of blood pressures from the ages of 4 through 18. Based on these data, different levels of blood pressure are defined: normal blood pressure, borderline hypertension, confirmed hypertension and life threatening hypertension. The confirmation of a renovascular disease as the cause of a child's hypertension is based on the elevation of the peripheral plasma renin level, the captopril tests, possibly the renal vein renin determinations and the imaging studies. The medical management is based on the use of antihypertensive drugs: diuretics, calcium-channel blockers, beta blockers, a blockers, converting-enzyme inhibitors and angiotension II receptor antagonists. The treatment of childhood hypertension has been hampered by several factors: a lack of extensive scientific data and manufacturer's recommendations regarding the doses and pharmacokinetics, a lack of age-appropriate drug formulations and the lack of official authorization for the prescription of most of the antihypertensive drugs in children.