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Indian Pediatr 2010;47: 473-474 |
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Hypertension in Pediatric Patients |
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Tej K Mattoo
Professor of Pediatrics, Wayne State University School of
Medicine, Chief, Pediatric Nephrology & Hypertension,
Children’s Hospital of Michigan, Detroit, USA.
Email: [email protected]
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A
n increasing number of healthy
children and adolescents across the world are being diagnosed with
hypertension, which is an emerging problem that no pediatrician can afford
to ignore. The evidence from developed countries indicates a recent
increase in the prevalence of hypertension in children and young adults.
In a school-based study in the United States that involved 5102 children
with a mean age 13.5 years, the prevalence of hypertension was 4.5%(1).
Primary hypertension, once considered a rare occurrence in pediatric
patients, is seen more often particularly in obese patients. Other factors
that are responsible for increased prevalence of hypertension in children
include life style changes such as physical inactivity, increased intake
of high-calorie, high-sodium and low-potassium foods, use of caffeinated
and alcohol beverages, smoking, mental stress and sleep deprivation(2).
Recent scientific advances have enhanced our
understanding of the pathophysiological mechanisms involved in
hypertension. Recognition of monogenic genetic disorders such as Liddle’s
syndrome, glucocorticoid-remediable aldosteronism, and synd-rome of
apparent mineralocorticoid excess, have made it possible to diagnose and
treat effectively a group of patients who in the past would have been
diagnosed as having ‘essential hypertension." Advances in diagnostic tools
and the availability of a variety of newer antihypertensive medications,
many of which have undergone successful clinical trials in pediatric
patients, have made it easier to diagnose and treat hypertension in
children.
In 2004, the Fourth Task Force of the National High
Blood Pressure Education Program (NHBPEP) Working Group published its
recommendations on the diagnosis, evaluation and the treatment of high
blood pressure in children and adolescents in the United States(3). These
recommendations, in spite of some limitations, provide an excellent
resource that is bringing some consistency in the management of pediatric
patients with hypertension. Soon after its publication, a consensus
meeting of experts of the Indian Pediatric Nephrology group resulted in
the publication of a consensus statement on the "Evaluation and Management
of Hypertension" in children in India(4). These recommendations provide a
good starting point in the diagnosis and the management of hypertension in
children in India.
Unlike adults, the blood pressure in children varies
with age and nothing helps in the diagnosis of hypertension in children
more than knowing the normal blood pressure distribution in the local
age-appropriate population. In this issue of Indian Pediatrics, Raj
and colleagues report normal blood pressure distribution in healthy,
non-obese, children from Kerala State in India(5). The study involved a
large cohort of 20,263 students in the age group of 5-16 years. To keep it
consistent with the Fourth Task Force report, the authors derived the
blood pressure percentiles for all age groups based on age, gender and
height of their patients. This is helpful because it allows using the same
definitions for pre-hypertension and various stages of hypertension as
used in the Task Force report and the Indian consensus statement.
Besides providing invaluable data on normal BP in
children aged 5 to 16 years in Kerala, the study by Raj, et al.(5)
makes an interesting observation of higher diastolic BP in boys as well as
girls and higher systolic BP in girls in comparison to the published US
data. Similar trends in BP distribution have been reported by a few more
studies from the region. This observation needs to be confirmed by more
studies, and if found to be true, the possible explanations for this
variation need to be investigated.
Funding: National Institutes of Health (NIH)/National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Competing interests: None stated.
References
1. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman
RJ. Overweight, ethnicity, and the prevalence of hypertension in
school-aged children. Pediatrics 2004; 113: 475-482.
2. Mitsnefes MM. Hypertension in children and
adolescents. Pediatr Clin North Am 2006: 53: 493-512.
3. National High Blood Pressure Education Program.
Working Group on High Blood Pressure in Children and Adolescents.
Pediatrics 2004; 114: 555-576.
4. Bagga A, Jain R, Vijayakumar M, Kanitkar M, Ali U.
Evaluation and management of hypertension. Indian Pediatr 2007; 44:
103-121.
5. Raj M, Sundaram KR, Paul M, Kumar RK. Blood pressure distribution in
children. Indian Pediatr 2010; 47: 477-485.
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