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[Treatment of arterial hypertension in children]
1Service de néphrologie pédiatrique, hôpital Trousseau, Paris, France.
Insights
Pediatric hypertension, categorized as primary or secondary, is managed through lifestyle changes and medications. A stepped-care approach guides treatment, starting with basic interventions and progressing to combination therapies for severe cases.
Area of Science:
- Pediatrics
- Nephrology
- Cardiology
Context:
- Childhood hypertension presents as primary or secondary forms, with secondary hypertension often linked to kidney disease and posing greater severity.
- Management strategies encompass non-pharmacological interventions (diet, exercise, lifestyle) and pharmacological agents.
- Primary and mild hypertension cases in children may be adequately managed with non-pharmacological methods alone.
Purpose:
- To outline the classification of pediatric hypertension.
- To detail the pharmacological and non-pharmacological management strategies for hypertension in children.
- To describe a stepped-care titration approach for managing childhood hypertension.
Summary:
- Hypertension in children is classified into primary and secondary types, the latter being more severe and often kidney-related.
- Treatment involves lifestyle modifications and medications such as diuretics, vasodilators, and enzyme inhibitors.
- A stepped-care approach is recommended, progressing from initial treatments to combination therapies and advanced drugs like minoxidil for resistant cases.
Impact:
- Provides a framework for understanding and treating pediatric hypertension.
- Highlights the importance of a tailored, stepped approach to medication management.
- Emphasizes the role of non-pharmacological interventions in managing milder forms of childhood hypertension.
Abstract:
Hypertension in children is divided in 2 groups: primary hypertension and the secondary forms which are more severe and mostly due to kidney diseases. The medical management of hypertension includes non pharmacological intervention (diet, exercise, life-style) and pharmacological agents. The children with primary and mild hypertension may need only non pharmacological strategies. The main pharmacological agents used are: diuretics, vasodilators, sympathetic blockers, centrally acting agents, converting enzyme inhibitors. Except for hypertensive emergencies, the management of children with hypertension is facilitated by a stepped-care titration approach. Step 1: beta adrenergic blockers or vaso-dilators; step 2: combine beta adrenergic blockers with vaso-dilators or with diuretics or converting enzyme inhibitors alone; step 3: combine converting enzyme inhibitors with vaso-dilators and/or diuretics and/or beta adrenergic blockers; step 4: drugs include minoxidil, prazosin, labetalol.