Treatment Of Hypertension In Children Research Articles

Treatment of Hypertension in Children.

Hypertension is a real problem in children. It shows a tracking behaviour, representing a key risk factor for hypertension, cardiovascular disease, and end-organ failure in adulthood. However, the importance of addressing arterial hypertension in children is not limited to its risk of tracking into adulthood. Thus, early detection and management are crucial. Hypertension may be primary or due to secondary causes, and identification of this distinction is very important for the treatment setting. Importantly, the management of hypertension in children is crucial to prevent the well-known cardiovascular effects in adulthood. As demonstrated in the literature, healthy eating habits, together with regular physical activity, can have a major impact on reducing high blood pressure and preventing organ damage in children and adolescents. However, suppose these are not sufficient to treat hypertension. In that case, if patients are symptomatic and/or have additional metabolic conditions such as obesity, type diabetes mellitus, or chronic kidney disease, anti-hypertensive medication must be started. Recent guidelines have provided clear guidance on the treatment of hypertension and hypertensive crisis in pediatric age. On the other hand, there are currently few specific recommendations on the treatment of isolated nocturnal hypertension and treatment-resistant hypertension. This review aims to summarize the most recent recommendations for the treatment of hypertension and hypertensive crisis in children and the last years' knowledge and experience in treating childhood isolated nocturnal hypertension and resistant hypertension of childhood.

Captopril Polyvinyl Alcohol/Sodium Alginate/Gelatin-Based Oral Dispersible Films (ODFs) with Modified Release and Advanced Oral Bioavailability for the Treatment of Pediatric Hypertension.

Hypertension can begin in childhood; elevated blood pressure in children is known as pediatric hypertension. Contrary to adult hypertension, there is a scarcity of commercial medications suitable for the treatment of pediatric hypertension. The aim of this study was to develop orally dispersible films (ODFs) loaded with captopril for the treatment of hypertension in children. Captopril-loaded ODFs were composed of different blends of synthetic polymers, such as polyvinyl alcohol (PVA) and polyvinyl pyrrolidone, and natural polymers, such as sodium alginate (SA) and gelatin. The ODFs were characterized based on their mechanical and thermal properties, drug content, surface morphology, in vitro disintegration, in vitro release, and bioavailability. A novel HPLC method with precolumn derivatization was developed to precisely and selectively determine captopril levels in plasma. A low concentration of PVA and a high concentration of SA generated ODFs with faster hydration and disintegration rates. SA-based films exhibited fast disintegration properties (1-2 min). The optimized modified-release film (F2) showed significant (p < 0.05) enhancement in bioavailability (AUC = 1000 ng min/mL), with a value 1.43 times that of Capoten® tablets (701 ng min/mL). While the plasma concentration peaking was in favor of the immediate-release tablet, Tmax was significantly prolonged by 5.4 times for the optimized ODF (3.59 h) compared with that of the tablets (0.66 h). These findings indicate uniform and sustained plasma concentrations, as opposed to the pulsatile and rapid plasma peaking of captopril from the immediate-release tablets. These findings suggest that the modified release of oral films could offer more favorable plasma profiles and better control of hypertension than the conventional release tablets.

Hypertension in Patients with Insulin Resistance: Etiopathogenesis and Management in Children.

Insulin resistance (IR) is a key component in the etiopathogenesis of hypertension (HS) in patients with diabetes mellitus (DM). Several pathways have been found to be involved in this mechanism in recent literature. For the above-mentioned reasons, treatment of HS should be specifically addressed in patients affected by DM. Two relevant recently published guidelines have stressed this concept, giving specific advice in the treatment of HS in children belonging to this group: the European Society of HS guidelines for the management of high blood pressure in children and adolescents and the American Academy of Pediatrics Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Our aim is to summarize the main pathophysiological mechanisms through which IR causes HS and to highlight the specific principles of treatment of HS for children with DM.

The choice of antihypertensive drugs in the treatment of arterial hypertension in children and adolescents: retrospective study

Aim. To conduct a study of prescribed antihypertensive therapy in order to determine the criteria for choosing antihypertensive drugs and assess their effectiveness in children with arterial hypertension (AH).&#x0D; Materials and methods. A retrospective study was carried out. We have analyzed medical records of 102 children with AH aged 6 to 17 years, who were examined and treated at the Smolensk Regional Children's Clinical Hospital in the period from 01.01.2019 to 31.12.2019.&#x0D; Results. Based on the inclusion criteria, 102 children were selected for the retrospective study, of which 74 (72.6%) were boys and 28 (27.4%) girls. In 56 (54.9%) patients heredity was burdened by cardiovascular diseases in the line of parents and grandparents, in 46 (45.1%) patients heredity was not burdened. The most frequent complaints registered in the case histories of patients were: 89 (87.3%) headache, mainly in the occipital region; 18 (17.7%) dizziness; 16 (15.7%) stabbing pain in heart; 10 (9.8%) increased heart rate. In 31 (28.4%) of the examined children, grade I AH was detected; in 56 (54.9%) grade II AH; 6 (5.9%) autonomic dysfunction syndrome; 9 (8.8%) had labile AH. As a drug antihypertensive monotherapy for the treatment of hypertension in children and adolescents in the Russian Federation, five main pharmacological groups are recommended: angiotensin-converting enzyme inhibitors (ACE inhibitors); angiotensin receptor blockers; -blockers; calcium channel blockers (dihydropyridine); thiazide diuretics, which was confirmed by a retrospective analysis. Drug therapy for AH was prescribed to children after 612 months of ineffectiveness of non-drug therapy. Of the ACE inhibitors group, 46 (45.1%) patients were prescribed a drug enalapril, 5 (4.9%) fosinopril, 2 (2%) captopril. -blockers 11 (10.7%) patients were prescribed bisoprolol, 1 (1%) patient atenolol. From the group of angiotensin receptor blockers, 1 (1%) child was prescribed losartan, 1 (1%) irbesartan. Calcium channel blockers were recommended for 1 (1%) patient as amlodipine. Diuretics were prescribed to 1 (1%) child with the drug indapamide.&#x0D; Conclusion. Based on our study, it was found that angiotensin-converting enzyme inhibitors are the priority pharmacological group in the treatment of hypertension in children and adolescents.

PULMONARY HYPERTENSION IN INFANTS WITH BRONCHOPULMONARY DYSPLASIA: CAUSES, DIAGNOSIS, TREATMENT

Bronchopulmonary dysplasia (BPD) is a leading chronic pathology of premature infants, which changes the structure of the lungs and disrupts the development of pulmonary vessels. The most important cardiovascular complication of BPD is the development of pulmonary hypertension, which is diagnosed in about 25 % of severely ill infants. Pulmonary hypertension associated with BPD develops due to lung vascular abnormalities and remodeling of the pulmonary vasculature, both of which lead to an increase in vascular resistance and the development of right ventricular heart failure. The occurrence of this complication worsens the prognosis of survival in infants with BPD, prolongs the total duration of hospital stay, adversely affects long-term somatic and neurological development and increases the frequency of re-hospitalizations. All this justifies the need for timely diagnosis and treatment of pulmonary hypertension in children with BPD. This review presents new data, for the definition, diagnosis, and treatment of pulmonary hypertension associated with BPD.

Blood Pressure in Childhood and Adolescence.

Elevated blood pressure (BP) and hypertension commonly occur in children and adolescents and increase the risk of cardiovascular disease in adulthood. The purpose of this review is to summarize recent research in pediatric hypertension including changes in defining hypertension, BP measurement techniques, hypertension epidemiology, risk factors, treatment, and BP-related target organ damage. Defining pediatric hypertension using the 2017 American Academy of Pediatrics' updated Clinical Practice Guideline resulted in a larger proportion of children being classified as having elevated BP or hypertension compared with prior guidelines. Trends in the distribution of BP among US children and adolescents suggest that BP levels and the prevalence of hypertension may have increased from 2011-2014 to 2015-2018. Factors including a family history of hypertension, obesity, minority race/ethnicity, physical inactivity, high dietary intake of sodium, and poor sleep quality are associated with an increased prevalence of elevated BP and hypertension. Evidence of a linear relationship between systolic BP and target organ damage indicates that BP levels currently considered normal could increase the risk of target organ damage in childhood. Lifestyle changes, such as adhering to the Dietary Approaches to Stop Hypertension diet, are a central component of effectively reducing BP and have been shown to reduce target organ damage. Pharmacologic treatment using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is an effective and safe method for reducing BP among children with uncontrolled BP after implementing lifestyle changes. Research gaps in the prevention, detection, classification, and treatment of hypertension in children demonstrate opportunities for future study.

Stability study of a compounded oral solution of nicardipine for the treatment of hypertension in children

Nicardipine is an antihypertensive drug that may be used off-label by oral route to treat hypertension in children. Currently commercially available tablets are inappropriate for oral use in children and manufactured hard capsules are not suitable for easy dose individualization to achieve target blood pressure. We aimed to fulfill this lack of appropriate dose forms by developing an oral liquid formulation of nicardipine.We compounded an extemporaneous 2 mg/mL nicardipine solution in InOrpha® vehicle for oral use with 1% polysorbate 80. A HPLC-MS/MS stability-indicating method was developed and validated. The stability was assessed under room temperature and refrigerated storage conditions. Nicardipine concentration remained above 95% of the initial concentration for 90 days in both storage conditions, without apparition of degradation products.Organoleptic parameters, pH, osmolality, viscosity and density were assessed and remained stable throughout storage. A uniformity of content was maintained before and after agitation of the packaging bottles. Mass uniformity of delivered doses was also ensured. Finally, the formulation met the Pharmacopoeia specifications for microbiological contaminations.In this study we report a compounded formulation of nicardipine for oral use in pediatrics. This solution, which could be easily manufactured, is being used in our hospital. Pharmacological and clinical parameters including bioavailability, pharmacokinetics, efficacy and tolerance remain to be assessed.

Seasonal variation of blood pressure in children

Seasonal blood pressure (BP) variation is mostly found between the summer and winter months. Guidelines for diagnosis and treatment of hypertension in children have not considered this variation until recently. This review aims to present an overview of seasonal BP variation in childhood along with potential underlying pathophysiological mechanisms and long-term implications as well as conclusions for future studies. In pediatric cohorts, seven studies investigated seasonal changes in BP. These changes amount to 3.4–5.9 mmHg (or 0.5–1.5 mmHg per − 1 °C difference in environmental temperature) in systolic BP with a peak in fall or winter. Potential mechanisms and mediators of seasonal BP variation include sympathetic activation of the nervous system with an increase of urinary and plasma norepinephrine levels in the winter season. Additionally, the physical activity among children and adolescents was inversely correlated with BP levels. Temperature sensitivity of BP and pediatric BP levels predict future systolic BP and target-organ damage. Therefore, cardiovascular events may even be long-term complications of seasonal BP variation in pediatric hypertensive patients. Overall, these data strongly suggest an important effect of ambient temperature on BP in children. Additional studies in pediatric cohorts are needed to define how best to incorporate such variation into clinical practice.

Ambulatory blood pressure monitoring: A nurse practitioner run program.

Ambulatory blood pressure monitoring (ABPM) is a standard screening tool for the diagnosis of hypertension in children, adolescents, and adults. However, there is confusion and misunderstanding about which guidelines can provide the most accurate diagnostic values. At a large, free-standing pediatric hospital, ABPM testing was historically being conducted by both nephrology and cardiology departments. The nephrology service was using the American Heart Association (AHA) guidelines, published in 2014 for interpretation of results and for diagnosis of hypertension, whereas the cardiology service depended on the 2004 National High Blood Pressure Education Program (NHBEP) fourth report, which led to discrepancies in diagnosis of hypertension in this patient population. A nurse practitioner-led quality improvement project was designed and implemented to determine the best method of ABPM monitoring and test interpretation based on comparing results of patients using height, gender, and application of either the 2004 NHBEP fourth report or 2014 AHA guidelines. Using a retrospective chart review, ABPM monitoring results from both cardiology and nephrology services were reviewed and compared to identify the most accurate methods and to recommend changes to practice. Accuracy of interpretation for ABPM is best accomplished using the 2014 AHA guidelines. Using a single method of interpretation provides consistent diagnosis and treatment of hypertension in children. Nurse practitioners can apply this knowledge in other settings to manage hypertension and provide similar services in different settings, including primary care.

Methods of Physiotherapy in the Medical Rehabilitation of Children with Primary Arterial Hypertension

Introduction. Arterial hypertension (AH) is a widely occurring disease of the cardiovascular system in the children’s population, which often debuts in childhood, persists into adulthood, which dictates the need for early treatment and prevention of arterial hypertension. The formation of AH is associated with maladaptation of physiological mechanisms of self-regulation, with a complex interaction of psychosocial and genetic factors. The use of non-medicinal agents to reduce blood pressure is a starting approach in the treatment of children and adolescents with hypertension and complements medication therapy. Purpose. analysis of literature sources on the effectiveness of hardware physiotherapy methods in the treatment of hypertension in children. Discussion. In the treatment of children with hypertension, the leading role belongs to hardware physiotherapy technologies. Widely used sedative, hypotensive and vegetative-corrective methods are pathogenetically justified and can be used at all stages of arterial hypertension development. Transcranial pulsed electrotherapy (transcranial electrostimulation, electroson, infitotherapy), darsonvalization, aromafitotherapy and medicinal electrophoresis of sedatives belong sedative methods aimed at enhancing inhibitory processes in the Central nervous system. Amplipulster therapy, intermittent normobaric hypoxytherapy, low-intensity magnetic therapy, medicinal electrophoresis of spasmolytic drugs, EHF therapy, laser therapy, which lead to a decrease in arterial hypertension and improve microcirculation, are hypotensive methods. Bio-controlled aerionotherapy, aimed at correcting vegetative dysfunction, is a vegetative corrective method. Conclusion. Currently, there is a wide range of scientifically-based methods of hardware physiotherapy used in the medical rehabilitation of children with arterial hypertension, allowing to improve cerebral hemodynamics, normalize neurophysiological and hemodynamic processes in the Central nervous system, provide sedative and hypotensive effects, stimulate peripheral vasodepressor mechanisms, normalize neuroendocrine processes. The use of hardware physiotherapy methods in the complex treatment of hypertension can improve the quality of life of patients, achieve stable normalization of blood pressure, and reduce the risk of early cardiovascular diseases.

Orthostatic Hypertension in Children: An Update.

The concept of orthostatic hypertension in children was first proposed in 2012. The pathogenesis is not clear by now. Orthostatic hypertension is one of the important causes of orthostatic intolerance in children and is related to the development of essential hypertension in the future. It is commonly seen in older children, with dizziness and syncope as their main clinical manifestations. Non-drug therapy is the commonly used treatment strategy, which is effective to improve the orthostatic intolerance symptoms. In this paper, we reviewed the clinical studies on the pathogenesis, clinical characteristics, diagnostic criteria, and treatment of orthostatic hypertension in children, aiming to provide new insights for the future studies on pediatric orthostatic hypertension.

Hypertension in children and adolescents

Hypertension is a major health problem in most developed and developing countries. Worldwide, approximately 1 billion people have hypertension, and 13% of all deaths are closely related to hypertension. Recently, the prevalence of elevated blood pressure (BP) in children and adolescents has increased, probably due to the increased prevalence of overweight and obesity among youths. Increasing evidence suggests that adult hypertension has its antecedents in childhood, as childhood BP predicts adult BP. Additionally, pediatric hypertension may cause premature atherosclerosis and early development of cardiovascular disease. Therefore, the identification and treatment of hypertension in childhood is likely to have an important impact on long-term outcomes of cardiovascular disease. International hypertension guidelines for children and adolescents have recently been significantly revised, especially regarding the diagnosis of hypertension. This review presents the recent guidelines for the diagnosis, evaluation, management, and treatment of hypertension in children and adolescents.

Pediatric hypertension: A guideline update.

The prevalence of pediatric hypertension is growing. Hypertension during childhood remains a major risk factor for adverse cardiovascular events later in life. NPs should be aware of current guidelines on screening, diagnosis, and treatment of hypertension in children to improve care for this patient population.

Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents

Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.

Diagnostics and treatment of arterial hypertension in children and adolescents, overview of new clinical guidelines of the American Academy of Pediatrics

The article analyzes clinical guidelines oftheAmericanAcademy ofPediatrics dd 2017 “ClinicalPractice Guideline forScreening andManagement of High Blood Pressure in Children and Adolescents”. This document contains new values of blood pressure in children, replaces the term “prehypertension” with the term “elevated blood pressure”, provides a simplified classification of arterial hypertension in adolescents over 13 years and revisesthe guidelinesfor daily blood pressure monitoring and echocardiography. The documentspecifiesthe criteria for diagnosing increased body weight of the left ventricular myocardium, changesthe target blood pressure levels. This new guidelines helps to optimize the diagnostics and treatment of hypertension in children. At the same time there is need for further comprehensive analysis of clinicalrecommendations and assessment of their practicalsignificance for pediatrics.

Blood hypertension in childrens. Guideliness for diagnosis and treatment. Part 1. Pediatric Nephrology Branch, Chilean Pediatric Society

Hypertension (HT) in children and adolescents is an important pathology, associated with modi fiable and non-modifiable factors. In the pediatric, the prevalence of HT is around 3.5%, and it in creases progressively with age. The ideal method for diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. As published by the American Academy of Pediatrics (AAP), BP should be measured in children over 3 years of age once a year, and in children under 3 years of age, if it presents risk factors. Once HT has been confirmed, the evaluation should be directed towards the detection of a causative disease and the search for risk factors associated with primary HTN. The goal of treating primary and secondary HTN in pediatrics is to achieve a level of BP that decreases the risk of target organ damage. The therapeutic options include: treatment according to specific etiology, non-pharmacological and pharmacological. This document is the product of a collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with the aim of helping pediatricians and pediatric nephrologists in the diagnosis and treatment of hypertension in childhood. In this first part, the recommendations of the diagnosis and study are presented.

Treatment of hypertension in children and adolescents

The article presents the data on modern approaches to non-drug and drug treatment of hypertension in children and adolescents. The article analyzes the recommendations of the American Heart Association (2017) and the European Society of Hypertension (2016) for the treatment of arterial hypertension. The authors describe the possibilities of non-drug treatment by changing the diet and increasing the level of physical activity. The article presents data on multicenter randomized clinical studies on the use of the main groups of antihypertensive drugs in children and adolescents, recommendations on the target level of blood pressure in the treatment of hypertension. The authors present indications and contraindications to the prescription of antihypertensive drugs: angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers. The concept of using β -blockers for the treatment of arterial hypertension is revised. The authors consider the treatment of refractory arterial hypertension and treatment of hypertension with proteinuria, metabolic syndrome, dyslipidemia.

Diagnosis and treatment of hypertension in children

Hypertension refers to a systemic vascular disease mainly characterized by elevated systemic arterial blood pressure, which can cause damage to heart, brain, kidney and other vital organs.It is closely related to the death of patients with cardiovascular and cerebrovascular diseases and has become a major public health problem worldwide.Hypertension can be divided into primary hypertension and secondary hypertension.Children with primary hypertension have a low visit rate because of the insidious onset, slow progress and none obvious symptoms in the early period, which may contribute to hypertension in their adulthood.Acute onset, cardiovascular and neurological symptoms are common features of the secondary hypertension in children, which may lead to critical complications in a short term if no effective treatments are taken in time.For children with hypertension, non-pharmacological measures are often recommended as first-line therapy, but treatments with drugs are generally required to reduce blood pressure for a substantial proportion of children, especially those with organ damage.In recent years, some progress has been made in the research about pediatric hypertension.Nevertheless, health care providers are still embracing severe challenges in the diagnosis and treatment of pediatric hypertension currently.In this review, we will focus on the diagnosis, etiology and treatment of pediatric hypertension. Key words: Hypertension; Etiology; Diagnosis; Treatment

Zalecenia Sekcji Pediatrycznej Polskiego Towarzystwa Nadciśnienia Tętniczego dotyczące postępowania diagnostycznego i terapeutycznego w nadciśnieniu tętniczym u dzieci i młodzieży

Presented recommendations are an extended and actualized version of paediatric recommendations of Polish Society of Hypertension published in 2015. Since then, new studies have appeared on this subject, introducing a new classification of hypertension, newly described principles of management in risk groups and methods of assessing hypertensive target organ damage. The presented updated recommendations included changes introduced in the 2016 European Society of Hypertension recommendation and Recommendations of Children’s Memorial Health Institute in Warsaw. Recently published guidelines of American Academy of Paediatrics have been discussed. In the presented issue of guidelines, epidemiological information on the occurrence and incidence of hypertension in developmental age was added and classification of blood pressure values was updated. Subchapters on diagnosis and organ damage assessment, principles of diagnosis and treatment of hypertension in children with diabetes, chronic kidney disease and a subsection discussing diagnostic and therapeutic difficulties with setting blood pressure targets were revised. In addition, the principles of early diagnosis of arterial hypertension in post-hospital care in children born before 33 weeks of gestation published in 2018 as recommendations of the Polish Neonatal Society have been also taken into account.

Management of high blood pressure in children: similarities and differences between US and European guidelines.

Over the last several decades, many seminal longitudinal cohort studies have clearly shown that the antecedents to adult disease have their origins in childhood. Hypertension (HTN), which has become increasingly prevalent in childhood, represents one of the most important risk factors for cardiovascular diseases (CVD) suchas heart disease and stroke. With the risk of adult HTN much greater when HTN is manifest in childhood, the future burden of CVD worldwide is therefore concerning. In an effort to slow the current trajectory, professional societies have called for more rigorous, evidence-based guideline development to aid primary care providers and subspecialists in improving recognition, diagnosis, evaluation, and treatment of pediatric HTN. In 2016 the European Society of Hypertension and in 2017 the American Academy of Pediatrics published updated guidelines for prevention and management of high blood pressure (BP) in children. While there are many similarities between the two guidelines, important differences exist. These differences, along with the identified knowledge gaps in each, will hopefully spur clinical researchers to action. This review highlights some of these similarities and differences, focusing on several of the more important facets regarding prevalence, prevention, diagnosis, management, and treatment of childhood HTN.