Evaluation of blood pressure in children

This review briefly highlights origins of hypertension with emphasis on the influences of gestation, birth weight, salt intake, and adiposity. We focus on the role of ambulatory blood pressure monitoring, and the assessment of comorbidity and target organ change in hypertensive children and adolescents.

Low birth weight, prematurity and uric acid levels are associated with hypertension early in childhood and in young adult life, not just in later adult life. Reduction of dietary salt intake leads to significant reductions in blood pressure in infants and young children. Newly applied techniques for assessment of target organ damage in children include arterial studies using retinal photography, ultrasound assessment of arterial intima-media thickness, and applanation tonometry.

Overweight and obesity are increasingly common, and are major determinants of high blood pressure in children, in both the developed and developing world. Initial evaluation of the hypertensive child must include carefully confirming if they are hypertensive using published reference data for blood pressure in children, and increasingly through ambulatory blood pressure monitoring. Left ventricular hypertrophy based on echocardiography remains the most widely used indirect marker of hypertensive end organ change. New techniques for assessing target organ damage are being developed.