Diagnostic Evaluation of Pediatric Hypertension

Abstract

A clinical challenge to the successful treatment of children with hypertension (HTN) is in the identification and evaluation of those children who will benefit from antihypertensive therapy (1). Additionally, consideration must be given to the causative spectrum of HTN in pediatric patients, as it is broad and changes with age. Most infants, toddlers, and school-aged children must be presumed to have secondary HTN. Essential HTN is most prevalent in adolescence and not dissimilar from that found in adults. For children with severe HTN—those above the 99th percentile—careful, comprehensive and immediate evaluation is required. A general rule for the identification of children at higher risk for secondary HTN is: the younger the child and the more severe the HTN, the more likely it is that a secondary cause will be found. Nontheless, older pediatric patients are still at risk and evaluation is important. The cause(s) of the child’s HTN may be remediable and may benefit from pharmacologic therapy. Also important to consider are children with diabetes and/or chronic kidney disease (CKD). Recent recommendations for these children include beginning therapy with antihypertensive medications, although the patient may be normotensive. Another recommendation for kidney and cardiovascular protection is that blood pressure (BP) be lowered to below the 90th percentile in children and <130/80 mmHg in older adolescents and adults (2). This chapter has been organized as a guideline for the clinician evaluating a new pediatric patient with HTN, with references to other chapters in this book for more detailed information of secondary HTN in children.