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Essential hypertension vs. secondary hypertension among children
Monesha Gupta-Malhotra1, Ashish Banker2, Sanjay Shete3
1Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas; monesha.gupta@uth.tmc.edu.
Insights
Essential hypertension is common in children, often diagnosed after age six. Children with essential hypertension tend to be older at diagnosis and have a family history of the condition.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Hypertension Research
Background:
- Assessing the prevalence and characteristics of essential hypertension in pediatric patients.
- Understanding hypertension in children is crucial for long-term cardiovascular health.
Purpose of the Study:
- To determine the proportions of essential hypertension among children in a pediatric hypertension clinic.
- To identify correlates associated with essential hypertension in pediatric populations.
Main Methods:
- Retrospective chart review of 423 children referred to a tertiary pediatric hypertension clinic.
- Data collection included demographic and clinical history for all patients.
Main Results:
- Essential hypertension was identified in 43% of 275 hypertensive children.
- Children with essential hypertension were older at diagnosis (median 12 years) compared to secondary hypertension (median 9 years).
- Stronger family history of hypertension (94% vs. 68%) and lower prevalence of preterm birth (20% vs. 46%) were noted in essential hypertension.
Conclusions:
- Essential hypertension is the predominant form in children over six years old.
- Early-onset essential hypertension can be diagnosed as early as age three.
- Key distinguishing factors for essential hypertension include older age at diagnosis, family history, and reduced preterm birth rates.
Background:
The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic.
Methods:
We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review.
Results:
We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents") from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3-17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08-19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P < 0.0001), and lower prevalence of preterm birth (20% vs. 46%; P < 0.001). There was a bimodal distribution of age of diagnosis in those with secondary hypertension.
Conclusions:
The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth.