Management Of Hypertension In Children Research Articles

Investigation and management of hypertension in children

The prevalence of hypertension in children is of the order of 1%-3%. Of these children, 10% will have severe hypertension and in the majority the increased blood pressure will be secondary to renal disease. Nephrologically orientated investigation is therefore important. The most helpful investigations are: peripheral plasma-renin activity, 99mTc dimercaptosuccinic acid (DMSA) scan, main and segmental renal vein renin measurements and renal angiography plus 123I metaiodobenzyl guanidine (MIBG) scan in suspected phaeochromocytoma. Drug treatment of accelerated hypertension is most successfully undertaken by intravenous labetalol or sodium nitroprusside; sustained moderate-to-severe hypertension by a beta-blocker plus a vasodilator or an angiotensin-converting enzyme inhibitor with or without a diuretic; mild hypertension by diet, diuretic and if necessary by more powerful hypotensives. Surgical treatment by revascularization or nephrectomy and percutaneous transluminal angioplasty can be successful. Utilizing the current range of investigational and therapeutic tools the aetiology and appropriate management of hypertension can be effectively and safely undertaken in the majority of hypertensive children.

Recommendations for Management of Hypertension in Children and Adolescents

Recommendations for Management of Hypertension in Children and Adolescents

Evaluation and Management of Childhood Hypertension

Hypertension in childhood is diagnosed according to age-adjusted values for each sex. It is more commonly diagnosed now than it was 2 decades ago because blood pressure is more frequently measured in children today. Surgically curable forms of hypertension are not common but usually present as moderate or severe hypertension (diastolic blood pressure greater than or equal to 110 mm Hg). Although many patients in this group are asymptomatic, some present with Bell's palsy, enlarged hearts, heart failure, encephalopathy, or stroke. Newer imaging techniques have proved particularly useful for localizing tumors, such as pheochromocytoma. Many antihypertensive drugs are now available, and therapy should be tailored to the patient's needs, with as few adverse or side effects as possible.

Renal vein renin measurement and arteriography in the investigation and management of severe childhood hypertension

Forty-two children aged one to sixteen years with persistent and severe hypertension were investigated by renal vein renin measurements. There were no serious complications in the 49 procedures performed and technical failure occurred on three occasions. Arteriography was performed in 35. Asymmetrical renin release was found in 22 patients and of these 15 underwent surgery. This was successful in 12 patients (80%) who became normotensive. Ten had unilateral disease (100% cure rate) but only 2 (40%) with bilateral disease became normotensive. Renal vein renin studies combined with arteriography have a useful role in the investigation and management of childhood hypertension.

Childhood Hypertension: Etiology, Diagnosis, and Treatment

The introduction of blood pressure measurements as an integral part of the routine care of children and adolescents has increased awareness of a significant incidence of hypertension in the pediatric age group. The concepts and principles discussed in this article provide a basis for the diagnosis and management of childhood hypertension.

Recent advances in evaluation and management of childhood hypertension.

Recent advances in evaluation and management of childhood hypertension.

Diagnosis and management of renovascular hypertension in children.

• Over the past 15 years, we have evaluated 107 hypertensive children. A renal origin of hypertension was identified in 30 patients, and 25 have undergone operative management. In the group undergoing operation, ages ranged from 2 months to 19 years. Twelve patients were male and 13 were female. Anatomic lesions included fibromuscular dysplasia (16 patients), renal artery trauma (two patients), renal artery involvement by aortic coarctation (two patients), chronic pyelonephritis (two patients), renal hypoplasia (two patients) and contralateral renal artery stenosis after irradiation for Wilms' tumor (one patient). The rapid sequence intravenous pyelogram was abnormal in only 52%. Renal revascularization was attempted in 17 patients. Nine patients had nephrectomy and three children had segmental resections. Bilateral procedures have been performed in four children. Follow-up observations from 4 months to 13 years (mean, four years) are available. Seventeen children (68%) were cured, six (24%) improved, and two (8%) had no change in blood pressure. Both children not improved and four of the six children showing only improvement had recurrent or residual renal artery disease limiting the result. Bilateral disease has occurred in seven of the 16 children (44%) with fibromuscular dysplasia. These results support an aggressive approach to the diagnosis and management of hypertension in childhood. The bilateral nature of fibromuscular dysplasia in these children stresses the long-term superiority of revascularization over nephrectomy in their management. ( Arch Surg 112:1307-1316, 1977)