Critical medicine topic-CMT 009
ELEVATED
BLOOD PRESSURE
IN THE PEDIATRIC POPULATION
1. Epidemiology
- Approximately 2%
of children have elevated systemic blood pressure.
2. Causes of Pediatric Hypertension
- Secondary
hypertension is much more common than primary hypertension.
- Renal
disease is
the leading cause.
Common renal causes include:
- Unilateral
hydronephrosis
- Unilateral
pyelonephritis
- Renal
tumors
- Multicystic
kidney
- Renal
artery occlusion
- Renal
artery stenosis
- Fibromuscular
dysplasia
- Acute
post-streptococcal nephritis
- Henoch–Schönlein
purpura (anaphylactoid purpura)
- Systemic
lupus erythematosus nephritis
3. Genetic Predisposition
- Children
of hypertensive parents have an increased risk of developing hypertension.
4. Blood Pressure Measurement in
Children
- Correct
cuff size is essential.
- Cuff
bladder should:
- Cover two-thirds
of the upper arm length
- Encircle
about three-fourths of the arm circumference
- Leave
the antecubital fossa free.
- A
cuff that is too small produces falsely elevated readings.
5. Normal Blood Pressure Values
- Blood
pressure rises with age.
- Age
2 years: approximately 95/60
mmHg
- Age
10 years: approximately 110/70
mmHg
6. Diagnostic Evaluation
The primary aim is to identify
secondary causes, particularly renal disease.
Investigations include:
- Urinalysis
- Complete
blood count
- Serum
electrolytes
- Blood
urea nitrogen (BUN)
- Serum
creatinine
- ECG
- Chest
X-ray
- Echocardiography
7. Role of Echocardiography
- Detects
early left ventricular hypertrophy (LVH)
- Evaluates
myocardial function
- Helps
monitor progression
- Assists
in deciding when antihypertensive therapy should begin
8. Indications for Drug Therapy
Treatment is recommended when:
- Diastolic
BP >85 mmHg in
children <12 years
- Diastolic
BP >90 mmHg in
children ≥12 years
- Presence
of left ventricular hypertrophy, even at lower blood pressures
9. Pharmacological Treatment
First-line therapy
- Thiazide
diuretics
Alternative agents
- ACE
inhibitors (e.g., captopril, enalapril)
- Calcium
channel blockers
10. Key Clinical Points
- Pediatric
hypertension is usually secondary.
- Renal
disorders are the commonest underlying cause.
- Family
history increases susceptibility.
- Proper
cuff selection is crucial for accurate diagnosis.
- Echocardiography
is valuable for early detection of target-organ damage.
- Early
treatment prevents long-term cardiovascular complications.
Critical clues
- Prevalence: ~2% of pediatric
population.
- Most
common cause: Secondary
renal hypertension.
- Most
important investigation: Evaluation for renal disease plus
echocardiography.
- Incorrect
cuff size: Small
cuff → falsely high BP.
- First-line
drug: Thiazide
diuretic.
- Treat
earlier if: Left
ventricular hypertrophy is present, regardless of lower diastolic
pressures.
DR.C.GANESAN
M.D.,
PROFESSOR
OF MEDICINE
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