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Published on: July 3, 2013
Treatment of hypertension in children with chronic kidney disease
1Division of Nephrology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OC.9.820, Seattle, WA, 98105, USA, susan.halbach@seattlechildrens.org.
Insights
Hypertension in pediatric chronic kidney disease is common but often missed. Early diagnosis and treatment, including RAAS inhibitors, are crucial for better outcomes and preventing complications.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Medicine
- Public Health
Background:
- Hypertension (HTN) is a frequent complication in pediatric chronic kidney disease (CKD).
- HTN is often underdiagnosed and undertreated in children with CKD.
- Untreated HTN negatively impacts CKD progression, cardiovascular health, and neurocognition.
Purpose of the Study:
- To review current understanding of HTN in pediatric CKD.
- To highlight the importance of timely diagnosis and management.
- To discuss updated guideline recommendations for BP targets and treatment.
Main Methods:
- Literature review of recent evidence and consensus guidelines.
- Analysis of the impact of HTN on pediatric CKD outcomes.
- Discussion of therapeutic strategies, including RAAS inhibitors.
Main Results:
- Evidence confirms HTN is prevalent and detrimental in pediatric CKD.
- Lower blood pressure targets are recommended in updated guidelines.
- Renin-angiotensin-aldosterone system (RAAS) agents are recommended as first-line therapy.
Conclusions:
- Aggressive management of HTN is essential in pediatric CKD.
- Multidrug therapy may be necessary for adequate blood pressure control.
- Addressing HTN improves CKD progression and reduces morbidity.
Abstract:
Hypertension (HTN) is increasingly recognized as a common feature of pediatric chronic kidney disease (CKD). A growing body of evidence demonstrates that HTN is both underdiagnosed and undertreated in this population. The consequences of untreated HTN include adverse effects on CKD progression, markers of cardiovascular morbidity, and neurocognitive functioning. Consensus guidelines issued over the past decade have incorporated recent research on the consequences of HTN in recommendations for the diagnosis and treatment of HTN in pediatric CKD and include lower BP targets. Agents which target the renin-angiotensin-aldosterone system (RAAS) should be considered first-line therapy in CKD-associated HTN in children, though multiple medications may be required to achieve sufficient BP control.
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