Hypertension in Children

Hypertension, also known as high blood pressure, is a medical condition that can affect individuals of all ages, including children. While it is more common in adults, hypertension in children is becoming increasingly recognized as a significant health concern.

Definition and Classification

Hypertension in children is defined as a systolic or diastolic blood pressure that is greater than or equal to the 95th percentile for age, sex, and height. The classification of hypertension in children is based on the severity of the condition, with stages ranging from prehypertension to stage 2 hypertension.

Causes and Risk Factors

The causes of hypertension in children can be primary (essential) or secondary. Primary hypertension accounts for approximately 90% of cases and is often associated with a combination of genetic, environmental, and lifestyle factors, such as:

• Family history of hypertension
• Obesity
• Sedentary lifestyle
• Diet high in sodium and low in potassium
• Poor sleep habits

Secondary hypertension, on the other hand, is often caused by underlying medical conditions, such as:

• Kidney disease or renal failure
• Heart defects or cardiovascular disease
• Endocrine disorders, such as hyperthyroidism or Cushing's syndrome
• Sleep apnea or other respiratory conditions

Diagnosis and Evaluation

The diagnosis of hypertension in children typically involves a combination of medical history, physical examination, and laboratory tests. The American Academy of Pediatrics recommends that blood pressure be measured in all children aged 3 years and older at least once per year.

The evaluation of hypertension in children may include:

• Complete medical history and physical examination
• Blood pressure measurement using a calibrated sphygmomanometer
• Urinalysis to check for proteinuria or hematuria
• Serum electrolyte panel to evaluate potassium, sodium, and chloride levels
• Renal ultrasound or other imaging studies to evaluate kidney function and structure

Treatment and Management

The treatment of hypertension in children depends on the severity of the condition and the presence of any underlying medical conditions. Lifestyle modifications are often recommended as the first line of treatment, including:

• Dietary changes, such as reducing sodium intake and increasing potassium-rich foods
• Increased physical activity and exercise
• Weight loss for obese children
• Stress reduction techniques, such as meditation or deep breathing exercises

Pharmacological treatment may be necessary in some cases, with medications such as:

• Angiotensin-converting enzyme (ACE) inhibitors
• Calcium channel blockers
• Diuretics
• Beta-blockers

Complications and Prognosis

Untreated or poorly managed hypertension in children can lead to significant complications, including:

• Kidney damage or disease
• Cardiovascular disease, such as heart failure or coronary artery disease
• Stroke or cerebral vasculature disease
• Vision problems or blindness due to hypertensive retinopathy

The prognosis for children with hypertension is generally good if the condition is diagnosed and treated early. Regular monitoring of blood pressure, lifestyle modifications, and pharmacological treatment as needed can help to reduce the risk of complications and improve long-term outcomes.