Pediatric hypertension: clinical perspective

To provide an overview of clinical aspects of hypertension in pediatric patients.

The recommended diagnostic studies and the management options for increased blood pressure levels in prepubertal and adolescent patients are reviewed.

In pediatric patients with three consecutive blood pressure measurements that exceed the 95th percentile, a hypertension-oriented personal and family history should be elicited, and a focused physical examination should be conducted for evidence of target organ damage, left ventricular hypertrophy, and potential causes of secondary hypertension. Subsequently, sequential laboratory and radiologic tests can be performed to validate clinical suspicions. Although children with hypertension usually have few symptoms, the major complaint is headache, which is characteristically frontal and may be throbbing. In the rare pediatric patient with malignant hypertension, severe headache, blurred vision, and seizures can occur, and the main underlying cause is renal parenchymal disorders. The management of children and adolescents with hypertension is based on an overall program for maintenance of cardiovascular health and implementation of measures directed at specific causes. If a young patient with hypertension has no evidence of cardiac involvement and remains asymptomatic during exercise testing, participation in sports can be encouraged.

Although blood pressure control is often difficult to achieve in young patients, the best pharmacologic approach is to use the fewest, well-studied drugs in the lowest effective dosage.