Abstract
The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem.This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children’s gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child’s age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention of high blood pressure is based on correct lifestyle and nutrition, starting from childhood age. The treatment of primary hypertension in children is almost exclusively dietary/behavioral and includes: a) reduction of overweight whenever present b) reduction of dietary sodium intake c) increase in physical activity. Pharmacological therapy will be needed rarely and only in specific cases.
Highlights
Before reference nomograms for blood pressure in childhood were available, the diagnosis of hypertension was made only in the presence of highly elevated blood pressure levels
The rise in the prevalence of overweight children and the increased survival rate of subjects with a very low birth weight may predict that the progression of hypertension prevalence in pediatric subjects will continue to aggravate
The Italian Society of Pediatrics and the Italian Society of Hypertension aim at providing the recommendations that are suitable for the Italian health care situation. These indications do not claim to be an exhaustive description of the problems of hypertension in the years of growth, but they intend to provide Pediatricians and Family Doctors with updated recommendations on prevention, diagnosis and treatment in order to prevent organ damage that might emerge if hypertension is not properly treated
Summary
Before reference nomograms for blood pressure in childhood were available, the diagnosis of hypertension was made only in the presence of highly elevated blood pressure levels. Longitudinal studies have shown that quite frequently children with elevated blood pressure levels are destined to become hypertensive adults [3]. These indications do not claim to be an exhaustive description of the problems of hypertension in the years of growth, but they intend to provide Pediatricians and Family Doctors with updated recommendations on prevention, diagnosis and treatment in order to prevent organ damage that might emerge if hypertension is not properly treated This task is not easy as there are no observational studies in children on the relationship between blood pressure values and cardiovascular events that may arise many years later. A diagnosis of hypertension based on an oscillometric measurement should be confirmed by an auscultatory method, using a non-mercury
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