Pediatric hypertension: An update on a burning problem

A large number of adults worldwide suffer from essential hypertension, and because blood pressures (BPs) tend to remain within the same percentiles throughout life, it has been postulated that hypertensive pressures can be tracked from childhood to adulthood. Thus, children with higher BPs are more likely to become hypertensive adults. These "pre-hypertensive" subjects can be identified by measuring arterial BP at a young age, and compared with age, gender and height-specific references. The majority of studies report that 1 to 5% of children and adolescents are hypertensive, defined as a BP > 95(th) percentile, with higher prevalence rates reported for some isolated geographic areas. However, the actual prevalence of hypertension in children and adolescents remains to be fully elucidated. In addition to these young "pre-hypertensive" subjects, there are also children and adolescents with a normal-high BP (90(th)-95(th) percentile). Early intervention may help prevent the development of essential hypertension as they age. An initial attempt should be made to lower their BP by non-pharmacologic measures, such as weight reduction, aerobic physical exercise, and lowered sodium intake. A pharmacological treatment is usually needed should these measures fail to lower BP. The majority of antihypertensive drugs are not formulated for pediatric patients, and have thus not been investigated in great detail. The purpose of this review is to provide an update concerning juvenile hypertension, and highlight recent developments in epidemiology, diagnostic methods, and relevant therapies.