Secondary Hypertension in Children-Identifying and Investigating at Risk Children

We aim to review the most recent literature on demographic features and diagnostic workup of children with secondary hypertension, in order to provide a framework for health providers to determine which hypertensive pediatric patients warrant further investigation for secondary causes. By highlighting the utility of various diagnostic investigations, we aim to minimize unnecessary testing burden.

A recent meta-analysis revealed that hypertensive children and adolescents with any of the following features were at increased risk of secondary hypertension: < 6 years of age, history of prematurity, family history of secondary hypertension, body mass index (BMI) < 10th percentile. Based on available evidence, we suggest a testing schema that is stratified by both age and BMI. Limited evidence suggest renal ultrasound may be one of the most useful initial investigations for secondary causes in asymptomatic hypertensive children. Lipid profile in overweight/obese children, and echocardiogram for end organ involvement may have high yield of abnormal results. Further studies on the diagnostic utility of tests for secondary hypertension are required, as the current body of evidence is limited.