POS-412 ETIOLOGIES AND MANAGEMENT OF HYPERTENSION IN CHILDREN: ABOUT A SERIES OF 41 CASE

Abstract

Hypertension is a very common finding in general pediatrics. A wide spectrum of etiologies is already known. But sometimes, finding the cause of hypertension and managing it can be challenging. We conducted a retrospective descriptive study including 41 children treated for hypertension from January 2015 to December 2019. We gathered data regarding the gender, age at onset, clinical manifestations, laboratory and radiology investigations, as well as management and outcome. The mean age a diagnosis was seven years, with 50% aged above 5 years. More than half of our patients were girls (60%). Symptoms at onset were mainly headache (25%), seizures (20%), ophthalmological manifestations (7.5%). The mean time between the onset of symptoms and diagnosis was 6 months. Meanwhile, the discovery of hypertension has been fortuitous in 55%. Causes of hypertension were divided as follows: chronic kidney disease in 50%, acute glomerulonephritis in 25%, segmental glomerular sclerosis in 12.5%, recessive renal polycystic disease in 5%. The remaining cases were hypertension caused by pheochromocytoma, hyperthyroidism, primary hyperaldosteronism, or renal artery stenosis. In one case, the cause was undetermined despite appropriate investigations. The majority (57%) of patients needed only one drug to control their blood pressure, while the others needed an association of two or more to reach blood pressure targets. Drugs mostly used to treat hypertension in our children were calcic inhibitors (50%), CEI/ARBs (33%), and diuretics (33%). Despite appropriate management, complications of hypertension (like hypertensive retinopathy, nephropathy, and/or stroke) were observed in about 37% of our children. At last, complete remission of hypertension (after specific treatment) was observed in 30% of patients, and those were the cases with acute glomerulonephritis, pheochromocytoma, and hyperparathyroidism. Childhood hypertension can be underdiagnosed in a lot of paucisymptomatic cases. This can lead to an increase in the incidence of the complications of chronic hypertension. That is why, to lower that risk and improve prognosis, sensibilization of all health practitioners to the right method of blood pressure measurement and interpretation in the pediatric population is mandatory.