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Investigation of pediatric hypertension. Use of a tailored protocol
1Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Simple clinical data is insufficient for diagnosing hypertension in children. Thorough investigation, including renal imaging, is crucial for identifying secondary hypertension causes in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Clinical Pediatrics
- Hypertension Research
Background:
- Essential hypertension is common in children, but secondary causes, often renal, require identification.
- Distinguishing between essential and secondary hypertension in pediatric patients is clinically challenging.
- Current diagnostic methods using basic clinical data have limitations in identifying the etiology of hypertension.
Purpose of the Study:
- To evaluate the efficacy of simple clinical data (history, physical exam, urinalysis) in differentiating essential from secondary hypertension in pediatric patients.
- To assess the diagnostic utility of specific clinical findings in identifying secondary causes of hypertension in children.
- To propose an effective protocol for the comprehensive investigation of hypertension in children.
Main Methods:
- Retrospective review of 103 pediatric patients (2 weeks to 18 years) referred for hypertension investigation.
- Analysis of clinical data including patient history, physical examination findings, and urinalysis results.
- Comparison of diagnostic yield of simple clinical data versus established diagnostic categories.
Main Results:
- Essential hypertension was the most frequent diagnosis (55/103), even in infants.
- Renal disorders accounted for the majority of secondary hypertension cases (21/103).
- Family history and hypertension lability/fixity were not reliable indicators of secondary hypertension; urinalysis detected inflammatory but not structural renal lesions.
Conclusions:
- Simple clinical data and urinalysis have limited value in distinguishing essential from secondary hypertension in children.
- Thorough investigation, including renal imaging, is essential for diagnosing the cause of hypertension in asymptomatic children.
- A comprehensive protocol is recommended for effective hypertension workup in pediatric patients.
Abstract:
Using a comprehensive protocol, the efficacy of simple clinical data, including history, physical examination, and urinalysis, in the discrimination of essential or secondary hypertension was investigated by a review of 103 patients, aged 2 weeks to 18 years, consecutively referred for investigation. Essential hypertension (55/103 mm Hg) was the most common diagnosis, even in infancy, whereas various renal disorders formed the next most common diagnostic category (21/103 mm Hg). Family history and the presence of "fixed" vs "labile" hypertension were of no value in detecting secondary hypertension. Urinalysis was useful in detecting inflammatory renal lesions but not structural disorders of the kidney. This study emphasizes the need for thorough investigation, including renal imaging, of asymptomatic hypertensive children and suggests a useful protocol to achieve this end.