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Elevated blood pressures in infants and children
Insights
Routine blood pressure measurement in children is crucial for detecting hypertension, which affects 1-10% of pediatric patients. Early detection and evaluation are vital as childhood hypertension often has identifiable causes treatable with medical or surgical intervention.
Area of Science:
- Pediatrics
- Cardiology
- Nephrology
Background:
- Elevated blood pressure (hypertension) is present in 1-10% of children.
- Many children with hypertension are asymptomatic, while others present with nonspecific symptoms.
- Childhood hypertension often has a specific, treatable cause, unlike adult hypertension.
Purpose of the Study:
- To emphasize the importance of routine blood pressure measurement in all infants and children.
- To outline an approach for evaluating children with transient or persistent hypertension.
- To discuss the medical management of acute hypertension in pediatric patients.
Main Methods:
- Routine measurement of blood pressure using appropriately sized cuffs.
- Comparison of observed pressures with age-specific normal values.
- Thorough evaluation for underlying causes in children with confirmed hypertension.
Main Results:
- Hypertension prevalence varies (1-10%) based on age and definition used.
- Thirty to fifty percent of hypertensive children are asymptomatic.
- Common causes include renal disease and coarctation of the aorta.
Conclusions:
- Routine blood pressure screening is essential in pediatric care.
- Identifying and treating the underlying cause of hypertension in children is key.
- A systematic diagnostic and management approach is necessary for pediatric hypertension.
Abstract:
Blood pressure should be routinely measured in all infants and children. Measurements should be performed with an appropriate size cuff and observed pressures compared to normal values for age. Elevated blood pressure is seen in one to ten percent of children, depending on the age group surveyed and the definition of hypertension selected. Thirty to fifty percent of children with elevated blood pressures are asymptomatic. The remainder have symptoms which are nonspecific, including headaches, visual disturbances, seizures, congestive heart failure, and facial palsy. Hypertension in children, unlike hypertension in the adult, usually has a definite cause which often responds to adequate medical and/or surgical treatment. For this reason, children with well-confirmed hypertension should be thoroughly evaluated. The most common causes of hypertension found in children are renal disease (pyelonephritis, vascular disease, structural malformations) and coarctation of the aorta. An approach to the child with transient or persistent hypertension is described. Diagnostic studies should be individualized and should follow clinical clues where possible. Medical management of the child with acute hypertension is discussed.