[Management of hypertension in children]

Treatment of hypertension depends on the cause and severity of hypertension, and wether it is acute or chronic hypertension. In hypertensive emergencies, antihypertensive therapy should be started immediately, even if the cause of the disease is unknown. If the hypertension is present for a short time, blood pressure could be normalized quickly, but if the hypertension is of long or unknown lasting, blood pressure should be normalized gradually, so in that way blood pressure is normalized in 2 to 4 days. In long-term antihypertensive therapy as little as possible drugs should be used, preferably in one or two daily doses. Depending on etiology and pathophysiology of hypertension, we use following drugs, alone or in combination: beta adrenergic blockers (atenolol, propranolol), vasodilators (hydralazine, minoxidil), ACE inhibitors (captopril, enalapril), calcium-channel blockers (nifedipine), diuretics (hydrochlorthiazide, frusemide) and alpha adrenergic blockers (prazosin, phenoxybenzamine). Recently, ACE inhibitors or calcium-channel blockers have been used as the first step in antihypertensive therapy. Surgical treatment includes elimination of tumors (Wilms tu, pheochromocytoma), coarctation of the aorta, revascularisation or percutaneous angioplasty (stenosis of renal artery) and parcial or unilateral nephrectomy in renal scarring. Nonpharmacological management: weight reduction, physical conditioning, dietary modifications etc. accompany pharmacological therapy in children with moderate-to-severe hypertension and are commonly recognized strategies to control mild elevations of blood pressure in children.