• A thorough eye examination should be performed.
  • The only routine laboratory tests that should be performed are as follows: urine dipstick, blood electrolytes, blood urea nitrogen, and creatinine. Other laboratory tests should be ordered based on both the history and the physical examination.

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    How is childhood hypertension treated?

    All children with significant, sustained hypertension should be treated. The treatment of hypertension is divided into two major categories: hypertensive crisis and chronic hypertension.

    1. Hypertensive crisis Hypertensive crisis is defined as life-threatening hypertension that is associated with hypertensive encephalopathy (changes in the brain and neurologic function due to the increased blood pressure) and/or acute heart failure. The calcium-channel blockers amlodipine and nifedipine are very effective in treating hypertensive crisis. Other medications used include diazoxide, nitroprusside, and minoxidil. No matter what medication is used, once acute blood pressure reduction is achieved, other medicines need to be added to maintain long-term blood pressure control.
    2. Chronic hypertension The ideal therapy for chronic hypertension is to treat, if possible, the underlying disease that is responsible for the hypertension. If this is not possible, then nonpharmacologic (not using medications) and pharmacologic (using medications) intervention is needed.

    Until recently, diuretics and beta-blockers were the most commonly used drugs to treat childhood hypertension. However, most pediatricians are now reluctant to use them because of evidence suggesting that these agents may adversely affect plasma lipids and insulin sensitivity. Beta-blockers also can cause depression and impair school performance.

    Other antihypertensive agents used to treat refractory hypertension include centrally-acting drugs (e.g., Clonidine, Guanabenz), alpha-blockers, and vasodilators (e.g., hydralazine, minoxidil).

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    What is the goal of hypertension treatment?

    The goal of therapy is to keep the child's blood pressure below the 90th percentile for age and sex. Parents must be taught not only to monitor their child's blood pressure at home, but also to monitor for signs of medication-induced side effects.

    Successful therapy should not interfere with the child's academic performance, involvement in sports, or interest in social activities. Participation in team sports should be encouraged unless there is clear evidence of heart dysfunction.

    Once the child's blood pressure is under good control, the child should be evaluated (at least) on an annual basis to assess cardiac status, physical growth and development, and sexual maturation patterns.

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    References

    Report of the Second Task Force on Blood Pressure Control in Children. Pediatrics 1987;79(1):1-25.

    Sinaiko AR. Pharmacologic management of childhood hypertension. Pediatr Clin North Am 1993;40(1):195-212.

    Falkner B. Management of hypertensive children and adolescents. In: Izzo JL, Black HR, eds. Hypertension primer: the essentials of high blood pressure. 2nd ed. American Heart Association, 1999:424.

    About the Author

    Dr. Rocchini received both his bachelor of science degree in chemical engineering and his medical degree from the University of Pittsburgh. He completed his pediatric residency at the University of Minnesota and his pediatric cardiology fellowship at the Children's Hospital of Boston. Dr. Rocchini is currently a professor of pediatrics and serves as director of pediatric cardiology at the University of Michigan. His research interests include interventional cardiac catheterization and obesity-induced hypertension.

    Copyright 2012 Albert P. Rocchini, M.D., All Rights Reserved