Hypertension In Pediatric Patients Research Articles

Pediatric Hypertension: A Condition That Matters.

Systemic hypertension has been considered mainly as an adult health issue for a long time, but it is now being increasingly acknowledged as a significant problem also among pediatric patients. The frequency of pediatric hypertension has grown mostly because of increases in childhood obesity and sedentary lifestyles, but secondary forms of hypertension play a role as well. Considering that unaddressed hypertension during childhood can result in enduring cardiovascular complications, timely identification and intervention are essential. Strategies for addressing this disease encompass not only lifestyle adjustments, but also the use of medications when needed. Lifestyle modifications entail encouraging a nutritious diet, consistent physical activity, and the maintenance of a healthy weight. Moreover, educating both children and their caregivers about monitoring blood pressure at home can aid in long-term management. Thus, the aim of this review is to discuss the etiologies, classification, and principles of the treatment of hypertension in pediatric patients.

Systemic steroids in pediatric pseudotumor cerebri - A case report

Study design: Case report. Purpose: To study the efficacy of systemic steroids in pediatric pseudotumor cerebri. Introduction: Pseudotumor cerebri is a condition caused by elevated intracranial pressure presenting most commonly with headache. It is a diagnosis of exclusion. Methods: A 15-year-old girl presented in our outpatient department with a headache for 3 months, more in the posterior aspect, continuous type with severe intensity, non-radiating. On examination, the best corrected visual acuity in her right eye was 6/9, and her left eye was 6/6 parts. She had a normal anterior segment and normal Intraocular Pressure (IOP). Fundoscopy showed both optic discs edematous, pink in color with blurry disc margins, tortuous disc vessels, and edematous peripapillary area. The rest of the retina was normal. Lumbar puncture showed elevated opening CSF pressure and normal CSF composition. Hence she was diagnosed with IIH. She was started on oral prednisolone 1mg/kgbw once a day dosage, oral acetazolamide 250 mg once a day, topical nepafenac 0.1% one drop thrice a day and timolol 0.5% eye drops twice a day. Discussion: The main goals of treatment are alleviation of symptoms, including headache, and preservation of vision. Steroids were commonly used for treating IIH in the past, but cause significant long-term side effects, such as weight gain, that are undesirable in IIH patients. Furthermore, withdrawal of steroids can cause rebound intracranial hypertension. Thus, steroids should not be used routinely for IIH treatment. Results: By the end of one month, the patient was relieved of symptoms, best corrected visual acuity was 6/6 in both eyes with normal IOP, normal optic disc in both eyes. Conclusion: Steroids are an effective way of managing idiopathic intracranial hypertension in pediatric patients.

Leukotriene B4 levels in CHD-associated paediatric pulmonary hypertension.

The aim of this study is to evaluate the role of leukotriene B4, an inflammatory mediator, in the development of pulmonary hypertension in paediatric patients with CHD with left-right shunt. The study included forty patients with CHD with left-right shunts. Based on haemodynamic data obtained from cardiac diagnostic catheterisation, 25 patients who met the criteria for pulmonary arterial hypertension were included in the patient group. The control group comprised 15 patients who did not meet the criteria. The standard cardiac haemodynamic study was conducted. Leukotriene B4 levels were assessed in blood samples taken from both pulmonary arteries and peripheral veins. The median age of patients with pulmonary arterial hypertension was 10 months (range: 3-168), while the median age of the control group was 50 months (range: 3-194). In the pulmonary hypertension group, the median pulmonary artery systolic/diastolic/mean pressures were 38/18/24 mmHg, compared to 26/10/18 mmHg in the control group. Leukotriene B4 levels in pulmonary artery blood samples were significantly higher in the pulmonary arterial hypertension group compared to the controls (p < 0.05). Peripheral leukotriene B4 levels were also elevated in the pulmonary arterial hypertension group in comparison to the control group, though the difference was not statistically significant. The discovery of elevated leukotriene B4 levels in pulmonary artery samples from paediatric patients with pulmonary arterial hypertension secondary to CHD with left-to-right shunt suggests that local inflammation may have a pathological role in the development of pulmonary arterial hypertension.

Pathophysiology, Diagnosis, and Management of Portal Hypertension in the Pediatric Population

AbstractPortal hypertension is caused by resistance to the portal blood flow, which most commonly occurs in the setting of cirrhosis. Complications of portal hypertension can cause significant morbidity and mortality in the pediatric population. Portal hypertension is diagnosed when the hepatic venous pressure gradient (HVPG) is more than 5 mm Hg, and potential bleeding complications from esophageal and gastric varices are more likely when the HVPG is more than 10 mm Hg. Diagnosis can be made clinically; however, liver biopsy with measurement of the HVPG is ultimately required. The management of portal hypertension in pediatric patients is typically aimed at treatment of the complications. Despite the multiple pharmacologic, endoscopic, surgical, and interventional radiologic management techniques that are available, some pediatric patients will ultimately require liver transplant. Prompt referral is needed in such cases.

Occipital emissary vein existence and its impact on the diagnosis of idiopathic intracranial hypertension in pediatric patients.

This study aimed to investigate the efficacy of occipital emissary vein (OEV) detection in the diagnosis of idiopathic intracranial hypertension (IHH) in the pediatric age group, and to compare the prevalence and luminal diameter of OEV in patients with IHH and in healthy control subjects. Conventional magnetic resonance imaging findings were assessed in the patients with IHH and in healthy control subjects who were under the age of 18, by two observers. The presence and luminal dimension of OEV and transverse sinus stenosis were also evaluated and compared between these two groups with magnetic resonance venography techniques. The rate of OEV existence was 7 times higher in the IIH group compared to the control group based on the second observer outcome (p = 0.010, OR = 7.0), with a very good interobserver agreement (Ƙ = 0.85). The dimension of OEV ranged between 0.6 and 2.5mm. There was no correlation found between the opening pressure and the dimension of OEV (p = 0.834). In conclusion, OEV existence could be an additional radiological finding for diagnosing IHH among pediatric patients, alongside other conventional findings.

Postoperative intra-abdominal hypertension predicts worse hospital outcomes in children after cardiac surgery: a pilot study†.

Our goal was to determine the incidence and characteristics of postoperative intra-abdominal hypertension (IAH) in paediatric patients undergoing open-heart surgery. This single-centre study included consecutive children (aged <16 years) who underwent open-heart surgery between July 2020 and February 2021. Patients who entered the study were followed until in-hospital death or hospital discharge. The study consisted of 2 parts. Part I was a prospective observational cohort study that was designed to discover the association between exposures and IAH. Postoperative intra-abdominal pressure was measured immediately after admission to the intensive care unit and every 6 h thereafter. Part II was a cross-sectional study to compare the hospital-related adverse outcomes between the IAH and the no-IAH cohorts. Postoperatively, 24.7% (38/154) of the patients exhibited IAH, whereas 3.9% (6/154) developed abdominal compartment syndrome. The majority (29/38, 76.3%) of IAH cases occurred within the first 24 h in the intensive care unit. Multivariable analysis showed that the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score [odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.23-2.83, P = 0.004], right-sided heart lesion (OR = 5.60, 95% CI 2.34-13.43, P < 0.001), redo sternotomy (OR = 4.35, 95% CI 1.64-11.57, P = 0.003), high baseline intra-abdominal pressure (OR = 1.43, 95% CI 1.11-1.83, P = 0.005), prolonged cardiopulmonary bypass duration (OR = 1.01, 95% CI 1.00-1.01, P = 0.005) and deep hypothermic circulatory arrest (OR = 5.14, 95% CI 1.15-22.98, P = 0.032) were independent predictors of IAH occurrence. IAH was associated with greater inotropic support (P < 0.001), more gastrointestinal complications (P = 0.001), sepsis (P = 0.003), multiple organ dysfunction syndrome (P < 0.001) and prolonged intensive care unit stay (z = -4.916, P < 0.001) and hospitalization (z = -4.710, P < 0.001). The occurrence of a composite outcome (P = 0.009) was significantly increased in patients with IAH. IAH is common in children undergoing cardiac surgery and is associated with worse hospital outcomes. Several factors may be associated with the development of IAH, including basic cardiac physiology and perioperative factors. This study was registered in the Chinese Clinical Trial Registry (Trial number: ChiCTR2000034322)URL site: https://www.chictr.org.cn/hvshowproject.html?id=41363&v=1.4.

Captopril to Lisinopril Conversion in Pediatric Cardiothoracic Surgery Patients Less Than 7Years of Age (RISE-7).

Hypertension after cardiothoracic surgery is common, often requiring pharmacologic management. The recommended first-line antihypertensives in pediatrics are angiotensin converting enzyme inhibitors. Captopril and enalapril are approved for infants and children; however, lisinopril is only approved for > 7years of age. This study evaluated safety and efficacy of converting from captopril to lisinopril in patients utilizing a pre-defined conversion of 3mg captopril to 1mg lisinopril. This was a single center, retrospective study including patients less than 7years of age admitted for cardiothoracic surgery who received both captopril and lisinopril from 01/01/2017 to 06/01/2022.The primary outcome was mean change in systolic blood pressure (SBP) from baseline for 72h after conversion of captopril to lisinopril. A total of 99 patients were enrolled. There was a significant decrease in mean SBP (99.12mmHg vs 94.86mmHg; p = 0.007) with no difference in DBP (59.23mmHg vs 61.95mmHg; p = 0.07) after conversion to lisinopril. Of the 99 patients who were transitioned to lisinopril, 79 (80%) had controlled SBP, 20 (20%) remained hypertensive, 13 (13%) received an increase in their lisinopril dose, and 2 (2%) required an additional antihypertensive agent. There was a low overall rate of AKI (3%) and hyperkalemia (4%) respectively. This study demonstrates that utilizing lisinopril with a conversion rate of 3mg of captopril to 1mg of lisinopril was safe and effective for controlling hypertension in pediatric patients following cardiothoracic surgery.

Outcomes of meso-Rex bypass for prehepatic portal hypertension in pediatric patients

Portal hypertension in pediatric patients is often associated with prehepatic portal hypertension (PHPH), frequently linked to thrombosis and cavernomatous degeneration of the portal vein (CDVP). This study evaluates the efficacy of the MesoRexBypass (MRB) in managing PHPH and associated thrombosis. MethodsA retrospective prognostic cohort design was employed to analyze the clinical outcomes of nine pediatric patients who underwent MRB between 2020 and 2022. Clinical and surgical variables were examined, including graft type, surgical time, and complications. Postoperative follow-up confirmed MRB functionality. ResultsThe MRB proved highly successful, with improved clinical parameters observed in all patients. Significant reductions in gastrointestinal bleeding, esophageal varices, and hypertensive gastropathy were observed postoperatively. Thrombocytopenia and liver enzyme levels showed substantial improvement, indicating enhanced liver function and amelioration of hypersplenism. The MRB's adaptability was demonstrated using autologous grafts and various graft sources.One patient experienced shunt thrombosis, another experienced minor gastrointestinal bleeding, and another died. The MRB exhibited a high success rate and few complications. ConclusionThe MRB is an effective and versatile surgical technique for managing PHPH in pediatric patients. This study emphasizes its promising outcomes and suggests its potential for enhancing treatment approaches and quality of life in this patient population. Further research with larger cohorts is needed to strengthen the evidence presented. The MRB holds promise as a valuable addition to the management of PHPH in children. Level of Evidence IV.

Ambulatory blood pressure monitorisation in children with recombinant growth hormone treatment.

It is safe to use recombinant growth hormone in children. Studies have shown it to be effective and safe, except for a few side effects in the short and long term after treatment. The present study investigated the presence of hypertension in pediatric patients receiving growth hormone treatment using 24 h ambulatory blood pressure monitoring (ABPM). This study is a single-center, retrospective study. Eighty-four patients aged 5-16 years who received growth hormone treatment for at least 3months, who underwent 24 h ABPM were analyzed. They were compared with 67 patients who had no risk factors for hypertension. In the study, 84 rhGH-treated patients (45.2 % male, 54.8 % female) and 67 healthy control groups (49.3 % male, 50.7 % female) were analyzed. The mean age of the patient group was 10.83±2.85 years and the mean age of the healthy control group was 13.1±2.93 years. The diagnostic classification of the patients receiving treatment was as follows: 66.6 % (n=56) partial growth hormone deficiency, 22.6 % (n=19) growth hormone deficiency, 7.1 % (n=6) bioactive growth hormone, 2.3 % (n=2) idiopathic short stature, 1.1 % (n=1) low birth weight for gestational age (SGA). Body mass index was significantly lower in the treated group (p=0.013). The duration of treatment was 6.04±4.9months. Daytime diastolic blood pressure was significantly lower in the treated group (p=0.001). There was no correlation between BMI and ABPM parameters in the treatment group and the control group. The present study shows that growth hormone treatment is safe in terms of high blood pressure.

Population pharmacokinetics of lisinopril in hypertensive children and adolescents with normal to mildly reduced kidney function.

Lisinopril, an angiotensin-converting enzyme inhibitor, is a frequently prescribed antihypertensive drug in the paediatric population, while being used off-label under the age of 6years in the USA and for all paediatric patients globally. The SAFEPEDRUG project (IWT-130033) investigated lisinopril pharmacokinetics in hypertensive paediatric patients corresponding with the day-to-day clinical population. The dose-escalation pilot study included 13 children with primary and secondary hypertension who received oral lisinopril once daily in the morning; doses ranged from 0.05 to 0.2mg kg-1 . Patients were aged between 1.9 and 17.9years (median 13.5years) and weight ranged between 9.62 and 97.2kg (median 53.2kg). All data were analysed using Monolix version 2020R1 (Lixoft, France) and R version 3.6.2. A 1-compartment model with first-order absorption and first-order elimination optimally describes the data. Parameter estimates of absorption rate constant (0.075 h-1 [0.062, 0.088], typical value [95% confidence interval]), volume of distribution (31.38 L 70 kg-1 [10.5, 52.3]) and elimination clearance (24.2L h-1 70 kg-1 [19.5, 28.9]) show good predictive ability. Significant covariate effects include total body weight on elimination clearance, and distribution volume and estimated glomerular filtration rate (eGFR) on elimination clearance. The effects of eGFR on the elimination clearance are optimally described by a linear effect centred around 105 mL min-1 1.73 m-2 . The effects of body weight were implemented using fixed allometric exponents centred around an adult weight of 70 kg. Lisinopril dose and regimen adjustments for paediatric patients should include eGFR on top of weight adjustments. An expanded model characterizing the pharmacodynamic effect is required to identify the optimal dose and dosing regimen.

Physician-Pharmacist Collaborative Drug Therapy Management in Pediatric Hypertension.

Pediatric hypertension affects 2% to 5% of children and adolescents in the United States and is frequently undertreated. The increasing prevalence of pediatric hypertension and worsening physician shortage create difficulties in closing this treatment gap. Physician-pharmacist collaborations have been shown to improve patient outcomes in adult patients. Our aim was to demonstrate a similar benefit for pediatric hypertension. Pediatric patients whose hypertension was managed at a single pediatric cardiology clinic from January 2020 to December 2021 were enrolled in collaborative drug therapy management (CDTM). Patients whose hypertension was managed in the same clinic from January 2018 to December 2019 were used as a comparison group. The primary outcomes were achievement of at-goal blood pressure at 3, 6, and 12 months and time to control of hypertension. Secondary outcomes were appointment adherence and serious adverse events. A total of 151 patients were included in the CDTM group, and 115 patients were included in the traditional care group. Of those, 100 CDTM patients and 78 traditional care patients were assessed for the primary outcome. Fifty-four (54%) CDTM patients and 28 (36%) traditional care patients achieved at-goal blood pressure at 12 months (OR, 2.09; 95% CI, 1.14-3.85). Appointment non-adherence was 9.4% for CDTM and 16% for traditional care (OR, 0.54; 95% CI, 0.35-0.82). Adverse events were similar between groups. CDTM increased rates of at-goal blood pressure without increased adverse events. Physician-pharmacist collaboration may improve treatment of hypertension in pediatric patients.

Prevalence of arterial hypertension in pediatric hospitalized patients.

To establish the prevalence of arterial hypertension in pediatric patients hospitalized in a tertiary hospital center in Medellin, Colombia for 6 years. A descriptive cross-sectional study was carried out that reviewed retrospective information obtained from the clinical records of patients under 18 years of age hospitalized at the Pablo Tobón Uribe Hospital in Medellín. From a total of 382 pediatric patients hospitalized in the studied period, a prevalence of hypertension of 30.6% was found. Systolic hypertension prevalence was 23.6% and diastolic 20.7%. Age under 5, treatment with vancomycin and critical care admission increased the risk of being hypertensive during hospitalization. In children the frequency of hypertension in hospitalized patients is higher than the prevalence reported in outpatients. The highest risk group and potentially modifiable factors must be recognized and treatment administered in a timely manner. Secondary complications are low, except for left ventricular hypertrophy, which requires long-term follow-up.

Evaluation of subclinical changes in recently diagnosed pediatric hypertension patients without hypertensive retinopathy: an OCT study.

To investigate subclinical choroidal and retinal changes in recently diagnosed pediatric hypertension (HT) patients. This prospective case-control study consisted of 62 treatment naive HT patients (34 essential HT and 28 renal-induced HT) and 62 control subjects aged 10-16years. All demographic data and ocular parameters were noted. Macula and choroid measurements were acquired by spectral domain optical coherence tomography (SD-OCT). Choroidal measurements were obtained by taking the mean of the measurements taken from 3 nasal and 3 temporal locations at 500µ intervals (mean nasal, mean temporal) in addition to the subfoveal area. All choroidal thickness (ChT) values in HT subjects were significantly lower than in the healthy group (p < 0.001 for all). Also, there was no statistically significant difference between central macular thickness (CMT) and mean macular thickness (MMT) between the two groups. Subfoveal ChT, mean ChT, and CMT values were statistically lower in patients with renal-induced HT compared to essential HT subjects (p < 0.001, p = 0.04, p = 0.014, respectively). No significant correlation was observed between choroidal thicknesses and blood pressure values in essential and renal HT groups except weak correlation between mean temporal ChT and systolic blood pressure (SBP) in renal HT group (r = - 0.464, p = 0.013). This study demonstrated that choroidal thickness decreased even during the subclinical period in treatment naive pediatric HT subjects. In addition, it has been shown that the choroid is more affected in renal-induced HT compared to essential HT group.

The prevalence of hypertension in paediatric Turner syndrome: a systematic review and meta-analysis.

Cardiovascular related deaths account for over 40% of the excess mortality in Turner syndrome (TS). Hypertension, a modifiable risk factor for both aortic dilatation and dissection, is more commonly encountered in TS during childhood and adolescence. Treatment of hypertension is currently recommended beyond the age of 16 years in TS to help reduce the risk of aortic dissection. This study aims to determine the prevalence of hypertension in paediatric patients with TS and explore the associated methodologies of blood pressure evaluation reported in these studies. Three online databases were searched (Medline, Embase and Web of Science) for literature which reported a prevalence, or allowed calculation of prevalence, of hypertension in patients with TS who were 18 years of age or younger. Seventeen studies which met the primary eligibility criteria, with a total of 1948 patients, were included. The estimated pooled prevalence of hypertension in children and adolescents with TS was 16% (95% CI: 8.9-24.6%). There was significant heterogeneity detected between the studies. The prevalence of hypertension in those studies which assessed 24-h Ambulatory Blood Pressure Monitoring (ABPM) was 21.1% (95% CI: 15.2-27.6%) compared those which used another method of blood pressure measurement which was 13.5% (95% CI: 5.2-24.4%). Given the impact of hypertension with long-term health outcomes and the reversibility of these same outcomes by addressing abnormal blood pressure, prompt and early diagnosis of hypertension in young girls with TS should be prioritised. We recommend the use of 24-h ABPM in screening for hypertension in the paediatric TS population.

Abstract 13501: Gaps in Care With Pediatric Hypertension Diagnosis: Role of Social Determinants of Health

Background: Primary hypertension (HTN) in pediatrics is a significant public health concern with increasing prevalence. The risk for adult HTN and end-organ damage begins in childhood. Therefore, evidence-based guidelines were developed by the American Academy of Pediatrics (AAP) in 2017 with detailed recommendations on screening and diagnosis. Ongoing follow-up is essential for diagnosis (at least 3 follow-up visits are needed to diagnose HTN if BP is high). However, gaps in care(GIC) exist in detecting and diagnosing HTN in clinical practice with barriers to accurate HTN detection at the patient, provider, and health system levels. Patient factors such as social determinants of health (SDoH), including the Childhood Opportunity Index (COI), leading to GIC with recommended follow-up needed for HTN diagnosis at primary care visits are poorly understood. Methods: A total of 69,960 patients aged 6-22 years seen at Nemours Children’s Health in DE and PA between August 2017- March 2019 formed the cohort. SDoH, including language, race, ethnicity, and COI, were explored. Data were analyzed using descriptive statistics and logistic regression. Results: Only 596 patients(0.9%) had HTN or were recognized as having a high BP. 73%(432) patients had over a 1-year GIC. GIC was associated with insurance type(P=0.05) and having 2 or fewer caregivers(P=0.004). GIC was not associated with race, ethnicity, language, interpreter use, or COI. Conclusions: Despite evidence-based guidelines, HTN detection remains poor. Patient factors, including insurance and the number of caregivers, likely lead to GIC with follow-up for HTN in pediatric patients. However, GIC for routine HTN follow-up are not broadly associated with SDoH. Other barriers likely exist at the provider and health system level leading to GIC and poor HTN detection.

TCT-406 Long-Term Results of Transcatheter Closure of Large Patent Ductus Arteriosus With Severe Pulmonary Arterial Hypertension in Pediatric Patients

TCT-406 Long-Term Results of Transcatheter Closure of Large Patent Ductus Arteriosus With Severe Pulmonary Arterial Hypertension in Pediatric Patients

Prevalence of pulmonary hypertension in pediatric patients with beta-thalassemia major in Central India: a cross sectional study

Background: The objective of the study was to determine the prevalence of pulmonary hypertension in pediatric patients with beta thalassemia major in a tertiary care centre in Central India.Methods: A cross sectional study was conducted in department of pediatrics, Government Medical College and Hospital, Nagpur, India over a period of 2 years. Total 100 subjects of thalassemia major diagnosed by high performance liquid chromatography (HPLC) attending day care in this department were enrolled for study. Measurement of pulmonary pressure was done by using 2D echocardiography with Doppler studies and tricuspid regurgitant jet velocity was measured. This was done by experienced cardiologist. Variables predictive of pulmonary hypertension studied were age, sex, serum ferritin levels, age of onset of chelation therapy, compliance to chelation therapy and number of blood transfusion per year.Results: Out of 100 subjects, 18 subjects had pulmonary hypertension. Univariate analysis proved that age, serum ferritin levels, age of onset of chelation therapy, compliance to chelation therapy and number of blood transfusion per year were significant predictors of pulmonary hypertension. While, multiple logistic regression analysis revealed that only 3 variables that is age of onset of chelation therapy, number of blood transfusion per year and compliance to chelation therapy retained their significance in this patient population.Conclusions: Prevalence of pulmonary hypertension was found out to be 18%. 2 subjects in the pulmonary hypertension group died. High morbidity and mortality of pulmonary hypertension clearly indicates that much work is needed in disease detection and development of more effective therapies. For thalassemic children, early detection and prevention of pulmonary hypertension in childhood would improve survival, reduce morbidity and mortality.

Assessing 48 SNPs in Hypertensive Paediatric Patients and Young Adults with Review of Genetic Background of Essential Hypertension.

Essential hypertension in paediatric patients and young adults is rising, mostly on account of obesity-related hypertension. Clinically, the difference between obese hypertensive and non-obese hypertensive individuals is evident; yet, the pathophysiology of essential and obesity-related hypertension is multifactorial, complex and not fully understood. The aim of our study was to obtain a comprehensive view of the clinical differences between obesity-related hypertension and hypertension in non-obese paediatric patients and young adults and to do genetic tests to possibly highlight some of the pathophysiological differences with a review of their genetic backgrounds. Four hundred and thirty-six hypertensive paediatric patients and young adults were included in the study, and a study of 48 single-nucleotide polymorphisms, using Kompetitive allele specific PCR, was conducted. The subjects were divided into 243 non-obese participants with hypertension and 193 obese participants with hypertension. The data for the clinical comparison of both groups were collected as well. The differences in some clinical and biochemical parameters were confirmed. Genetic tests showed a significant difference in one allele frequency between both groups in five SNPs: rs6232, rs6235, rs12145833, rs59744560 and rs9568856. In rs6235 and rs59744560, a direct effect of different allele states could be implied. Obesity-related hypertension at a young age differs from essential hypertension in those non-obese. The reported genetic differences could be important in understanding the complex pathophysiology of early-onset obesity-related hypertension and should be further evaluated.

Lifestyle Interventions for Elevated Blood Pressure in Childhood-Approaches and Outcomes.

The purpose of this review is to provide an overview of existing and emerging lifestyle treatments in the clinical management of primary elevated blood pressure and hypertension in pediatric patients. The authors hope to expand the knowledge base surrounding pediatric hypertension and update clinicians on best practices to improve outcomes. Elevated blood pressure is traditionally addressed with broad lifestyle recommendations such as limiting salt consumption and losing weight. This approach is not well adapted for pediatric patients. Novel and often underutilized approaches to the treatment of hypertension in pediatrics include psychological counseling for behavior modification, circadian nutrition, consistent use of interdisciplinary teams, manipulation of macronutrients, stress management, technology-infused interventions, and systemic changes to the food environment. Elevated blood pressure is a pervasive condition affecting cardiovascular disease and mortality risk. Increasingly, pediatric patients are presenting with elevated blood pressure with etiologies known to be affected by lifestyle behaviors. Weight management, dietary modifications, and daily physical activity are well-researched methods for improving individual blood pressure measurements. These strategies can sometimes be as effective as pharmacological interventions at lowering blood pressure. However, compliance with these individual recommendations is not consistent and has led to unsatisfactory results. There are emerging treatment trends that may provide non-traditional and more effective non-pharmacologic routes to blood pressure management in pediatric patients.

Chest computed tomography findings of ground-glass nodules with enhancing central vessel/nodule in pediatric patients with BMPR2 mutations and plexogenic arteriopathy.

Germline mutation in bone morphogenetic protein type II (BMPR2) is the most common cause of idiopathic/heritable pulmonary hypertension in pediatric patients. Despite the discovery of this gene there are no known descriptions of the CT or CT angiography findings in these children. To correlate the clinical presentation, pathology and chest CT findings in pediatric patients with pulmonary hypertension caused by mutations in the BMPR2 gene. We performed a search to identify pediatric patients with a BMPR2 mutation and CT or CT angiography with the clinical history of pulmonary hypertension. Three pediatric radiologists reviewed the children's CT imaging findings and ranked the dominant findings in order of prevalence via consensus. We identified three children with pulmonary hypertension and confirmed germline BMPR2 mutations, two of whom had undergone lung biopsy. We then correlated the imaging findings with histopathology and clinical course. All of our patients with BMPR2 mutations demonstrated a distinct CT pattern of ground-glass nodules with a prominent central enhancing vessel/nodule. These findings correlated well with the pathological findings of plexogenic arteriopathy.