Epidemiology of Secondary Hypertension in Children

Abstract

Secondary hypertension is more common in children compared with adults who predominantly have primary hypertension. Young age, severe hypertension, family history, and signs and symptoms of syndromes associated with hypertension are suggestive of an underlying secondary cause for elevated BP. Secondary hypertension is associated with more severe elevation in BP and, hence, early and prompt diagnosis with treatment addressing the underlying cause is needed for such patients. Renal conditions are the commonest cause of secondary hypertension in children and include chronic kidney injury, acute nephritic syndromes, renal artery stenosis, and renal scarring. Hypertension is also seen in association with Williams syndrome, neurofibromatosis, and others in association with renal vessel abnormalities. Iatrogenic steroid use for various conditions is one of the most common causes for hypertension in children. Other endocrine conditions associated with hypertension include catecholamine producing tumors (pheochromocytoma), corticoid hormone disorders (Cushing’s syndrome and disease, hyperaldosteronisn, congenital adrenal hyperplasia), and hyperthyroidism. Genetic forms of hypertension are rare but should be suspected in patients with early onset of elevated BP, young family members with hypertension and associated electrolyte abnormalities of alkalosis and hypokalemia.