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Ding FL, Elias I, Wright R, De Mello A, Cojocaru D, Dionne J. Yield of diagnostic testing in evaluating etiology and end organ effects of pediatric hypertension. Pediatr Nephrol 2024; 39:513-519. [PMID: 37515741 DOI: 10.1007/s00467-023-06101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Current recommendations regarding the utility of diagnostic investigations for pediatric hypertension are based on limited evidence, leading to wide practice variation. The objective of this study was to characterize the cohort of children that may benefit from secondary hypertension workup, and determine the diagnostic yield of investigations. METHODS This was a single-center, retrospective cohort study of 169 children aged 1-18 years referred between 2000 and 2015, to a tertiary pediatric nephrology center in Canada, for evaluation of hypertension. The number of investigations completed, abnormal findings, and diagnostic findings that helped establish hypertension etiology was determined. RESULTS 56 children were diagnosed with primary and 72 children with secondary hypertension in the outpatient setting. Secondary hypertension was predominant at all ages except for obese adolescents ≥ 12 years. Half of children with traditional risk factors for primary hypertension, including obesity, were diagnosed with secondary hypertension. Kidney ultrasound had the highest yield of diagnostic results (19.8%), with no difference in yield between age groups (P = 0.19). Lipid profile had a high yield of abnormal results (25.4%) as part of cardiovascular risk assessment but was only abnormal in overweight/obese children. Echocardiogram had a high yield for identification of target-organ effects in hypertensive children (33.3%). CONCLUSION A simplified secondary hypertension workup should be considered for all hypertensive children and adolescents. High yield investigations include a kidney ultrasound, lipid profile for overweight/obese children, and echocardiograms for assessment of target-organ damage. Further testing could be considered based on results of initial investigations for the most cost-effective management. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- FangChao Linda Ding
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Isaac Elias
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca Wright
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alanna De Mello
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dan Cojocaru
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
- Division of Nephrology, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
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2
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Stabouli S, Beropouli S, Goulas I, Chainoglou A. Diagnostic evaluation of the hypertensive child. Pediatr Nephrol 2024; 39:339-343. [PMID: 37650959 DOI: 10.1007/s00467-023-06127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Stella Stabouli
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
| | - Stavroula Beropouli
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - Ioannis Goulas
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
| | - Athanasia Chainoglou
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece
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3
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Chen Y, Ye P, Dong H, Xu X, Shi L, Li B, Dong J, Lv A, Su Z, Zhang Y, Zhou Y, Wang J, Feng G, Zeng Y, Ni X, Mi J. Clinical characteristics of pediatric hypertension: a multicenter study in China. J Hypertens 2023; 41:1753-1759. [PMID: 37602486 DOI: 10.1097/hjh.0000000000003533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVES Hypertension in children has attracted increasing attention. However, clinical-based studies investigating characteristics and secular trends of pediatric hypertension remain limited. This study aimed to investigate the clinical characteristics and secular trends of different types of hypertension among hospitalized children in China. METHODS This retrospective analysis was based on medical records from nine tertiary children's hospitals in China during 2010∼2020. A total of 5847 pediatric inpatients (aged <18 years) with the diagnosis of hypertension were enrolled. Information on the clinical characteristics of each patient was obtained from their first admission records. RESULTS During the past decade, secondary hypertension sustained to be the dominant type of hypertension in children, with the proportion increased from 51.2% during 2010∼2015 to 59.8% during 2016∼2020. The main causes of secondary hypertension were neurologic disorders in children aged 0∼2 years, which changed to renal diseases after 3 years of age. Compared with primary hypertension, secondary hypertension was common in girls (43.1 vs. 23.3%) and children under 5 years of age (32.2 vs. 2.1%). Moreover, over four-fifths of primary hypertensive individuals had obesity and obesity-related comorbidities, and the proportion of clusters of one or more comorbidities increased in the past decade (79.7 → 85.2%). CONCLUSION Secondary hypertension sustained to be the dominant type of hypertension among children, especially in girls. Renal diseases were the most common causes of secondary hypertension in children, followed by rheumatic immune diseases. For primary hypertension, over four-fifths of inpatients had obesity and obesity-related diseases, and the proportion kept rising.
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Affiliation(s)
- Yijun Chen
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
- School of Physical Education and Health, Hunan University of Technology and Business, Hunan
| | - Peiyu Ye
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Hongbo Dong
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Xin Xu
- Department of Information Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health
| | - Lin Shi
- Capital Institution of Pediatrics, Beijing
| | - Bin Li
- Kunming Children's Hospital, Kunming
| | - Jie Dong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha
| | - Aiting Lv
- Henan Children's Hospital, Zhengzhou
| | - Zhe Su
- Shenzhen Children's Hospital, Shenzhen
| | - Yong Zhang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan
| | - Yunguo Zhou
- Jiangxi Provincial Children's Hospital, Nanchang
| | | | | | - Yueping Zeng
- Department of Medical Record Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Jie Mi
- Center for Noncommunicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
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4
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Pearson K, Halbach SM. Continuing Medical Education Pediatric Hypertension: An Update on the American Academy of Pediatrics Clinical Practice Guidelines. J Pediatr Health Care 2023; 37:447-454. [PMID: 37407179 DOI: 10.1016/j.pedhc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/24/2023] [Accepted: 03/13/2023] [Indexed: 07/07/2023]
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5
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Haseler E, Singh C, Newton J, Melhem N, Sinha MD. Demographics of childhood hypertension in the UK: a report from the Southeast England. J Hum Hypertens 2022:10.1038/s41371-022-00732-7. [PMID: 35933484 DOI: 10.1038/s41371-022-00732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022]
Abstract
We aimed to describe hypertensive phenotype and demographic characteristics in children and adolescents referred to our paediatric hypertension service. We compared age, ethnicity and BMI in primary hypertension (PH) compared to those with secondary hypertension (SH) and white coat hypertension (WCH). Demographic and anthropometric data were collected for children and adolescents up to age 18 referred to our service for evaluation of suspected hypertension over a 6 year period. Office blood pressure (BP) and out of office BP were performed. Patients were categorised as normotensive (normal office and out of office BP), WCH (abnormal office BP, normal out of office BP), PH (both office and out of office BP abnormal, no underlying cause identified) and SH (both office and out of office BP abnormal, with a secondary cause identified). 548 children and adolescents with mean ± SD age of 10.1 ± 5.8 years and 58.2% girls. Fifty seven percent (n = 314) were hypertensive; of these, 47 (15%), 84 (27%) and 183 (58%) had WCH, PH and SH, respectively. SH presented throughout childhood, whereas PH and WCH peaked in adolescence. Non-White ethnicity was more prevalent within those diagnosed with PH than both the background population and those diagnosed with SH. Higher BMI z-scores were observed in those with PH compared to SH. Hypertensive children <6 years are most likely to have SH and have negligible rates of WCH and PH. PH accounted for 27% of hypertension diagnoses in children and adolescents, with the highest prevalence in adolescence, those of non-White Ethnicity and with excess weight.
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Affiliation(s)
- Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | | | - Joanna Newton
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Nabil Melhem
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK. .,Kings College London, London, UK.
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6
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Khandelwal P, Deinum J. Monogenic forms of low-renin hypertension: clinical and molecular insights. Pediatr Nephrol 2022; 37:1495-1509. [PMID: 34414500 DOI: 10.1007/s00467-021-05246-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
Monogenic disorders of hypertension are a distinct group of diseases causing dysregulation of the renin-angiotensin-aldosterone system and are characterized by low plasma renin activity. These can chiefly be classified as causing (i) excessive aldosterone synthesis (familial hyperaldosteronism), (ii) dysregulated adrenal steroid metabolism and action (apparent mineralocorticoid excess, congenital adrenal hyperplasia, activating mineralocorticoid receptor mutation, primary glucocorticoid resistance), and (iii) hyperactivity of sodium and chloride transporters in the distal tubule (Liddle syndrome and pseudohypoaldosteronism type 2). The final common pathway is plasma volume expansion and catecholamine/sympathetic excess that causes urinary potassium wasting; hypokalemia and early-onset refractory hypertension are characteristic. However, several single gene defects may show phenotypic heterogeneity, presenting with mild hypertension with normal electrolytes. Evaluation is based on careful attention to family history, physical examination, and measurement of blood levels of potassium, renin, and aldosterone. Genetic sequencing is essential for precise diagnosis and individualized therapy. Early recognition and specific management improves prognosis and prevents long-term sequelae of severe hypertension.
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Affiliation(s)
- Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Nugent JT, Young C, Funaro MC, Jiang K, Saran I, Ghazi L, Wilson FP, Greenberg JH. Prevalence of Secondary Hypertension in Otherwise Healthy Youths with a New Diagnosis of Hypertension: A Meta-Analysis. J Pediatr 2022; 244:30-37.e10. [PMID: 35120981 PMCID: PMC9086113 DOI: 10.1016/j.jpeds.2022.01.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/26/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of secondary hypertension among otherwise healthy children with hypertension diagnosed in the outpatient setting. STUDY DESIGN The MEDLINE, PubMed Central, Embase, Web of Science, and Cochrane Library databases were systematically searched for observational studies reporting the prevalence of secondary hypertension in children who underwent evaluation for hypertension and had no known comorbidities associated with hypertension at the time of diagnosis. Two authors independently extracted the study-specific prevalence of secondary hypertension in children evaluated for hypertension. Prevalence estimates for secondary hypertension were pooled in a random-effects meta-analysis. RESULTS Nineteen prospective studies and 7 retrospective studies including 2575 children with hypertension were analyzed, with a median of 65 participants (range, 9-486) in each study. Studies conducted in primary care or school settings reported a lower prevalence of secondary hypertension (3.7%; 95% CI, 1.2%-7.2%) compared with studies conducted in referral clinics (20.1%; 95% CI, 11.5%-30.3%). When stratified by study setting, there were no significant subgroup differences according to study design, country, participant age range, hypertension definition, blood pressure device, or study quality. Although the studies applied different approaches to diagnosing secondary hypertension, diagnostic evaluations were at least as involved as the limited testing recommended by current guidelines. CONCLUSIONS The low prevalence of secondary hypertension among children with a new diagnosis of hypertension identified on screening reinforces clinical practice guidelines to avoid extensive testing in the primary care setting for secondary causes in most children with hypertension.
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Affiliation(s)
- James T Nugent
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT.
| | - Chelsea Young
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, CT
| | - Kuan Jiang
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Ishan Saran
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Lama Ghazi
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT; Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Jason H Greenberg
- Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT
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8
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Melo FF, Vasconcelos MA, Mak RH, Silva ACSE, Dias CS, Colosimo EA, Silva LR, Oliveira MCL, Oliveira EA. Postnatal urinary tract dilatation classification: improvement of the accuracy in predicting kidney injury. Pediatr Nephrol 2022; 37:613-623. [PMID: 34453601 DOI: 10.1007/s00467-021-05254-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The grading of urinary tract dilatation (UTD) on postnatal sonography is a fundamental step to establish rational management for infants with antenatal hydronephrosis (ANH). The aim of this study was to compare the prediction accuracy of UTD grading systems for relevant clinical outcomes. In addition, we propose a refinement of the UTD classification by adding quantitative measurements and evaluate its impact on accuracy. METHODS Between 1989 and 2019, 447 infants diagnosed with isolated AHN were prospectively followed. The events of interest were surgical interventions and kidney injury. Comparison of performance of the grading systems and the impact on the accuracy of a modified UTD classification (including the size of the kidney parenchyma) was assessed by the area under the receiver-operating characteristic curve (AUC). RESULTS Of 447 infants, 131 (29%) underwent surgical intervention and 26 (5.8%) had developed kidney injury. The median follow-up time was 9 years (IQ range, 7-12 years). The performance for detecting the need for surgical intervention was excellent for all grading systems (AUC > 0.90). However, for predicting kidney injury, the modified UTD classification exhibited significant improvement in accuracy (AUC = 0.913, 95%CI, 0.883-0.937) as compared with UTD classification (AUC = 0.887, 95%CI, 0.854-0.915) (P = 0.027). CONCLUSIONS Our study confirms that the hydronephrosis grading systems provide excellent accuracy in discriminating patients who need surgical intervention among infants with AHN. Our findings suggest that the inclusion of kidney parenchymal thickness to UTD classification might increase the accuracy for predicting infants who may develop kidney injury. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Fernanda F Melo
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Mariana A Vasconcelos
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Ana Cristina Simões E Silva
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Cristiane S Dias
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ludmila R Silva
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Maria Christina L Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Eduardo A Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil. .,Visiting Scholar, Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA.
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9
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Garvick S, Ballen E, Brasher D, St Amand E, Ray O, Vera N, Gregory T. Guidelines for screening and managing hypertension in children. JAAPA 2021; 34:14-20. [PMID: 33315729 DOI: 10.1097/01.jaa.0000723904.18671.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT Pediatric hypertension has risen to an overall prevalence of 16.3%. If left untreated, hypertension in children and adolescents can have significant implications for cardiovascular and renal health into adulthood, including stroke, coronary artery disease, kidney disease, and heart failure. In 2017, the American Academy of Pediatrics (AAP) released updated guidelines for the screening, evaluation, and management of pediatric hypertension. This article reviews the definition of pediatric hypertension, describes why the guidelines were updated, and defines treatment protocol. By familiarizing themselves with and applying these guidelines, clinicians will be able to appropriately screen and manage hypertension in children to prevent morbidity into adulthood.
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Affiliation(s)
- Sarah Garvick
- Sarah Garvick is associate program director of the PA program at Wake Forest University in Winston-Salem, N.C., and practices clinically in the Appalachian District Health Department. At the time this article was written, Eliza Ballen, Danielle Brasher, Elizabeth St. Amand, Olivia Ray, and Natalie Vera were students in the PA program at Wake Forest University. Tanya Gregory is an assistant professor and director of student services in the PA program at Wake Forest University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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10
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Bouhanick B, Sosner P, Brochard K, Mounier-Véhier C, Plu-Bureau G, Hascoet S, Ranchin B, Pietrement C, Martinerie L, Boivin JM, Fauvel JP, Bacchetta J. Hypertension in Children and Adolescents: A Position Statement From a Panel of Multidisciplinary Experts Coordinated by the French Society of Hypertension. Front Pediatr 2021; 9:680803. [PMID: 34307254 PMCID: PMC8292722 DOI: 10.3389/fped.2021.680803] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Hypertension is much less common in children than in adults. The group of experts decided to perform a review of the literature to draw up a position statement that could be used in everyday practice. The group rated recommendations using the GRADE approach. All children over the age of 3 years should have their blood pressure measured annually. Due to the lack of data on cardiovascular morbidity and mortality associated with blood pressure values, the definition of hypertension in children is a statistical value based on the normal distribution of blood pressure in the paediatric population, and children and adolescents are considered as having hypertension when their blood pressure is greater than or equal to the 95th percentile. Nevertheless, it is recommended to use normative blood pressure tables developed according to age, height and gender, to define hypertension. Measuring blood pressure in children can be technically challenging and several measurement methods are listed here. Regardless of the age of the child, it is recommended to carefully check for a secondary cause of hypertension as in 2/3 of cases it has a renal or cardiac origin. The care pathway and principles of the therapeutic strategy are described here.
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Affiliation(s)
- Béatrice Bouhanick
- Service d'Hypertension Artérielle et Thérapeutique, CHU Rangueil, CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Philippe Sosner
- Centre Médico-Sportif MON STADE, Paris, France.,Hôpital Hôtel-Dieu, APHP, Centre de Diagnostic et de Thérapeutique, Paris, France.,Laboratoire MOVE (EA 6314), Université de Poitiers, Faculté des Sciences du Sport, Poitiers, France
| | - Karine Brochard
- Service de Néphrologie Médecine Interne Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Claire Mounier-Véhier
- Institut Cœur-Poumon, Médecine Vasculaire et HTA, CHU, Université Lille, EA 2694 - Santé Publique: Epidémiologie et Qualité des Soins Lille, Lille, France
| | - Geneviève Plu-Bureau
- Unité de Gynécologie Médicale, AP-HP, Hôpital Port-Royal, Université de Paris, Paris, France
| | - Sébastien Hascoet
- Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Filières Maladies Rares ORKID et ERK-Net, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
| | | | - Laetitia Martinerie
- Centre de Reference des Maladies Rares de la Croissance et du Développement, Université de Paris, Endocrinologie et Diabétologie Pédiatrique, AP-HP, Hôpital Robert-Debré, Paris, France
| | - Jean Marc Boivin
- Département de Médecine Générale, Université de Lorraine, Inserm CIC-P Pierre Drouin Vandœuvre-Lès-Nancy, Vandœuvre-lès-Nancy, France
| | - Jean Pierre Fauvel
- Service de Néphrologie Hospices Civils, Hôpital Edouard Herriot, Lyon, France.,UMR CNRS 5558, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Filières Maladies Rares ORKID et ERK-Net, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
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Chrysaidou K, Chainoglou A, Karava V, Dotis J, Printza N, Stabouli S. Secondary Hypertension in Children and Adolescents: Novel Insights. Curr Hypertens Rev 2020; 16:37-44. [PMID: 31038068 DOI: 10.2174/1573402115666190416152820] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022]
Abstract
Hypertension is a significant risk factor for cardiovascular morbidity and mortality, not only in adults, but in youths also, as it is associated with long-term negative health effects. The predominant type of hypertension in children is the secondary hypertension, with the chronic kidney disease being the most common cause, however, nowadays, there is a rising incidence of primary hypertension due to the rising incidence of obesity in children. Although office blood pressure has guided patient management for many years, ambulatory blood pressure monitoring provides useful information, facilitates the diagnosis and management of hypertension in children and adolescents, by monitoring treatment and evaluation for secondary causes or specific phenotypes of hypertension. In the field of secondary hypertension, there are numerous studies, which have reported a strong association between different determinants of 24-hour blood pressure profile and the underlying cause. In addition, in children with secondary hypertension, ambulatory blood pressure monitoring parameters offer the unique advantage to identify pediatric low- and high-risk children for target organ damage. Novel insights in the pathogenesis of hypertension, including the role of perinatal factors or new cardiovascular biomarkers, such as fibroblast growth factor 23, need to be further evaluated in the near future.
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Affiliation(s)
- Katerina Chrysaidou
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Athanasia Chainoglou
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Vasiliki Karava
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - John Dotis
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Nikoleta Printza
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
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Kotanidou EP, Giza S, Tsinopoulou VR, Vogiatzi M, Galli-Tsinopoulou A. Diagnosis and Management of Endocrine Hypertension in Children and Adolescents. Curr Pharm Des 2020; 26:5591-5608. [PMID: 33185153 DOI: 10.2174/1381612826666201113103614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
Abstract
Hypertension in childhood and adolescence has increased in prevalence. Interest in the disease was raised after the 2017 clinical practice guidelines of the American Academy of Paediatrics on the definition and classification of paediatric hypertension. Among the secondary causes of paediatric hypertension, endocrine causes are relatively rare but important due to their unique treatment options. Excess of catecholamine, glucocorticoids and mineralocorticoids, congenital adrenal hyperplasia, hyperaldosteronism, hyperthyroidism and other rare syndromes with specific genetic defects are endocrine disorders leading to paediatric and adolescent hypertension. Adipose tissue is currently considered the major endocrine gland. Obesity-related hypertension constitutes a distinct clinical entity leading to an endocrine disorder. The dramatic increase in the rates of obesity during childhood has resulted in a rise in obesity-related hypertension among children, leading to increased cardiovascular risk and associated increased morbidity and mortality. This review presents an overview of pathophysiology and diagnosis of hypertension resulting from hormonal excess, as well as obesity-related hypertension during childhood and adolescence, with a special focus on management.
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Affiliation(s)
- Eleni P Kotanidou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Styliani Giza
- Fourth Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasiliki-Regina Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Vogiatzi
- Division of Endocrinology and Diabetes, Children' s Hospital of Philadelphia, PA 19104, United States
| | - Assimina Galli-Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Çakıcı EK, Yazılıtaş F, Kurt-Sukur ED, Güngör T, Çelikkaya E, Karakaya D, Bülbül M. Clinical assessment of primary and secondary hypertension in children and adolescents. Arch Pediatr 2020; 27:286-291. [PMID: 32682663 DOI: 10.1016/j.arcped.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 01/19/2023]
Abstract
The aim of this study was to compare the clinical features of patients with elevated blood pressure and to detect variables associated with the diagnosis of primary hypertension. We identified 383 (69%) hypertensive children (197 [51.5%] with primary hypertension, and 186 [48.5%] with secondary hypertension) out of 553 children referred to our clinic with a history of elevated blood pressure. The primary hypertension group was significantly older and had higher BMI, positive family history of hypertension, and lower prevalence of preterm birth compared with those with secondary hypertension. No difference was found between the two groups in terms of the frequency of target organ damage. Multiple regression analysis showed that a family history of hypertension, obesity, age over 10 years, elevated uric acid, and presence of higher systolic blood pressure values at admission were independent predictors of primary hypertension; therefore, these parameters can be considered important clues for diagnosing primary hypertension.
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Affiliation(s)
- E K Çakıcı
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey.
| | - F Yazılıtaş
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - E D Kurt-Sukur
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - T Güngör
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - E Çelikkaya
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - D Karakaya
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
| | - M Bülbül
- Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Department of Pediatric Nephrology and Rheumatology, Ankara, Turkey
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Langhoff AF, Børresen ML, Wason MP, Andersson M, Jeppesen DL, Schmidt IM, Cortes D. National data with high validity and completeness showed that only 0.04% of Danish children had been registered with diagnosed hypertension. Acta Paediatr 2020; 109:1458-1464. [PMID: 31785102 DOI: 10.1111/apa.15116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/22/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
AIM Hypertension has been reported in up to 4.0% of American children, but no national data exist in Europe. We studied the frequency of registered hypertension in Danish children and evaluated the data. METHODS This 2014-2015 study focused on patients under the age of 16 registered with hypertension in the Danish National Patient Register and 10 paediatric departments in central and eastern Denmark. The diagnoses were coded according to the International Classification of Diseases, 10th revision. All the subjects' medical records were reviewed, including any confirmed diagnoses. RESULTS There were 55 784 children under 16 in the study regions at 30 April 2014. By May 2015, 222 of those had been registered with hypertension: 200 in the Danish National Patient Register and 191 in the 10 paediatric departments. Their medical records confirmed hypertension in 187 and 185 cases, respectively. The prevalence of registered and confirmed hypertension was 222/553 784 (0.04%). The positive predictive values of hypertension were 187/200 (94%) and 185/191 (97%), and the completeness of diagnosed hypertension was 187/222 (84%) and 185/222 (83%). CONCLUSION The registers had high-quality positive predictive values and completeness, but only 0.04% of the Danish children were registered with a verified diagnosis of hypertension.
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Affiliation(s)
- Adam F. Langhoff
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
| | - Malene Landbo Børresen
- Department of Paediatrics and Adolescent Medicine The Juliane Marie Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Malgorzata P. Wason
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital North Zealand Hillerød Denmark
| | - Mikael Andersson
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Dorthe L. Jeppesen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
- Faculty of Medical and Health Sciences University of Copenhagen Copenhagen Denmark
| | - Ida M. Schmidt
- Department of Paediatrics and Adolescent Medicine The Juliane Marie Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Dina Cortes
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
- Faculty of Medical and Health Sciences University of Copenhagen Copenhagen Denmark
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15
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Safdar O, Alaifan F, Alshammakh S, Hakami M, Alghaithi DF. Diagnostically Challenging Case of Renal Artery Stenosis in a Pediatric Patient. Cureus 2020; 12:e6538. [PMID: 31929955 PMCID: PMC6939964 DOI: 10.7759/cureus.6538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this study we report a diagnostically challenging case of bilateral renal artery stenosis (RAS) in a nine-year-old boy presenting as uncontrolled hypertension (HTN). The objective of this clinical case report is to draw attention to the unlikely combination of a classical clinical presentation with several normal investigations. This is a nine-year-old boy, known to have uncontrolled HTN, later diagnosed as a case of bilateral RAS. This patient underwent several imaging studies including: renal Doppler ultrasonography (US), diethylenetriamine pentaacetic acid (DTPA) scan, and mercaptuacetyltriglycine (MAG3) renal scintigraphy with captopril challenge, with the aim of determining the cause of his uncontrolled HTN. The previously mentioned imaging procedures were carried out at two different medical centers over an extended period of time; however, the images failed to show any anatomical abnormalities to explain his clinical presentation. Due to this unexpected result the primary team in charge of this case opted for a percutaneous transluminal angioplasty, as a diagnostic and therapeutic approach, by which the final diagnosis of bilateral RAS was concluded. During follow-up the patient was asymptomatic in all outpatient clinic appointments. Even though several initial investigations failed to indicate RAS, clinicians may pursue further investigations in cases of classical clinical presentation of uncontrolled HTN in pediatric population so as to not miss any diagnostically challenging cases.
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Affiliation(s)
- Osama Safdar
- Pediatrics, King Abdulaziz University, Jeddah, SAU
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16
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Begic Z, Begic N, Begic E, Secic D, Begic S. Use of continuous holter of blood pressure in pediatric population: Single-center experience and review of literature. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Lott BW, Kink RJ, Brown Lobbins ML, Nada A. Let’s Break the Tension. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Affiliation(s)
- Pamela S Singer
- Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-01 76th Avenue, New Hyde Park, NY 11040, USA.
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19
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20
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Abstract
The prevalence of elevated blood pressure and hypertension in children and adolescents has increased over the past decade. This trend is most likely related to increases in primary hypertension associated with increasing obesity rates in children. Lifestyle as well as genetics play a significant role in the development of primary hypertension. Hypertension in children and adolescents is under-recognized and undertreated. The 2017 Revised Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents aimed to create new normative blood pressure tables using data from healthy weight children, meaning between the 5th and 85th percentile per the Centers for Disease Control and Prevention. Another important objective was to simplify normative data to ease screening and detection of elevated blood pressures. The consequences of chronic hypertension are significant, with its major affect being in poor cardiovascular health outcomes both in childhood and early adulthood. Challenges to detection and adequate treatment should be overcome with continued education and awareness to prevent the long-term effects of uncontrolled hypertension that starts in childhood. [Pediatr Ann. 2018;47(12):e499-e503.].
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21
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2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 2017; 34:1887-920. [PMID: 27467768 DOI: 10.1097/hjh.0000000000001039] [Citation(s) in RCA: 696] [Impact Index Per Article: 99.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increasing prevalence of hypertension (HTN) in children and adolescents has become a significant public health issue driving a considerable amount of research. Aspects discussed in this document include advances in the definition of HTN in 16 year or older, clinical significance of isolated systolic HTN in youth, the importance of out of office and central blood pressure measurement, new risk factors for HTN, methods to assess vascular phenotypes, clustering of cardiovascular risk factors and treatment strategies among others. The recommendations of the present document synthesize a considerable amount of scientific data and clinical experience and represent the best clinical wisdom upon which physicians, nurses and families should base their decisions. In addition, as they call attention to the burden of HTN in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, these guidelines should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents.
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22
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:peds.2017-1904. [PMID: 28827377 DOI: 10.1542/peds.2017-1904] [Citation(s) in RCA: 1889] [Impact Index Per Article: 269.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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Affiliation(s)
- Joseph T Flynn
- Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology, Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - David C Kaelber
- Departments of Pediatrics, Internal Medicine, Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, Case Western Reserve University and MetroHealth System, Cleveland, Ohio
| | - Carissa M Baker-Smith
- Division of Pediatric Cardiology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Douglas Blowey
- Children's Mercy Hospital, University of Missouri-Kansas City and Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado-Denver and Pediatrician in Chief, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah D de Ferranti
- Director, Preventive Cardiology Clinic, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susan K Flinn
- Consultant, American Academy of Pediatrics, Washington, District of Columbia
| | - Samuel S Gidding
- Cardiology Division Head, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine and Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Corinna Rea
- Associate Director, General Academic Pediatric Fellowship, Staff Physician, Boston's Children's Hospital Primary Care at Longwood, Instructor, Harvard Medical School, Boston, Massachusetts
| | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Madeline Simasek
- Pediatric Education, University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Clinical Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Dillman JR, Smith EA, Coley BD. Ultrasound imaging of renin-mediated hypertension. Pediatr Radiol 2017; 47:1116-1124. [PMID: 28779201 DOI: 10.1007/s00247-017-3840-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/30/2017] [Accepted: 03/20/2017] [Indexed: 11/29/2022]
Abstract
The incidence of primary (i.e. essential) hypertension in children and adolescents is increasing; however, secondary hypertension, with an identifiable cause, remains relatively common and might be treatable or even curable. Renovascular hypertension is an uncommon but important secondary cause of hypertension in the pediatric population that can be associated with substantial morbidity. In this article we discuss renin-mediated causes of hypertension in children and related complications, review renal Doppler ultrasound techniques for the evaluation of renin-mediated hypertension (including both direct and indirect assessments), and briefly appraise the literature pertaining to renal Doppler ultrasound and the assessment of pediatric hypertension. Finally, we describe a proposed role for renal Doppler ultrasound in the workup of suspected renin-mediated hypertension in children and adolescents.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Division of Thoracoabdominal Imaging, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.
| | - Ethan A Smith
- Section of Pediatric Radiology, C. S. Mott Children's Hospital, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Brian D Coley
- Department of Radiology, Division of Thoracoabdominal Imaging, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA
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Harris KC, Benoit G, Dionne J, Feber J, Cloutier L, Zarnke KB, Padwal RS, Rabi DM, Fournier A. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, and Assessment of Risk of Pediatric Hypertension. Can J Cardiol 2016; 32:589-97. [DOI: 10.1016/j.cjca.2016.02.075] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 12/31/2022] Open
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Remedial operations for failed endovascular therapy of 32 renal artery stenoses in 24 children. Pediatr Nephrol 2016; 31:809-17. [PMID: 26628283 DOI: 10.1007/s00467-015-3275-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous transluminal angioplasty (PTA) for the treatment of pediatric renovascular hypertension (RVH) in contemporary practice is accompanied with ill-defined complications. This study examines the mode of pediatric renal PTA failures and the results of their surgical management. METHODS Twenty-four children underwent remedial operations at the University of Michigan from 1996 to 2014 for failures of renal PTA. Their clinical courses were retrospectively reviewed and results analyzed. RESULTS Renal PTA of 32 arteries, including 13 with stenting, was performed for severe RVH in 12 boys and 12 girls, having a mean age of 9.3 years. Developmental ostial stenoses affected 22 children. PTA failures included: 27 restenoses and five thromboses. Remedial operations included: 13 renal artery-aortic reimplantations, one segmental renal artery-main renal artery reimplantation, ten aortorenal bypasses, one arterioplasty, one iliorenal bypass, and six nephrectomies for unreconstructable arteries; the latter all in children younger than 10 years. Follow-up averaged 2.1 years. Postoperatively, hypertension was cured, improved, or unchanged in 25, 54, and 21 %, respectively. There was no perioperative renal failure or mortality. CONCLUSIONS Renal PTA for the treatment of pediatric RVH due to ostial disease may be complicated by failures requiring complex remedial operations or nephrectomy, the latter usually affecting younger children.
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Gralia NM, Yehle KS, Ahmed A, Ross M. Managing Hypertension Among Obese Children in Primary Care: Updated Evidence. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gupta-Malhotra M, Banker A, Shete S, Hashmi SS, Tyson JE, Barratt MS, Hecht JT, Milewicz DM, Boerwinkle E. Essential hypertension vs. secondary hypertension among children. Am J Hypertens 2015; 28:73-80. [PMID: 24842390 DOI: 10.1093/ajh/hpu083] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. METHODS We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. RESULTS We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents") from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3-17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08-19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P < 0.0001), and lower prevalence of preterm birth (20% vs. 46%; P < 0.001). There was a bimodal distribution of age of diagnosis in those with secondary hypertension. CONCLUSIONS The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth.
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Affiliation(s)
- Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas;
| | - Ashish Banker
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas
| | - Sanjay Shete
- Department of Biostatistics, MD Anderson Cancer Center, University of Texas Health Science Center, Houston, Texas
| | - Syed Sharukh Hashmi
- Pediatric Research Center, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas
| | - John E Tyson
- Division of Neonatology, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas
| | - Michelle S Barratt
- Divisions of Community and General Pediatrics and Adolescent Medicine, Department of Pediatrics, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas
| | - Jacqueline T Hecht
- Pediatric Research Center, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas
| | - Diane M Milewicz
- Division of Medical Genetics, Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas
| | - Eric Boerwinkle
- Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas
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Voiculescu A, Heusch A, Düppers P, Pourhassan S, Klee D, Rump LC, Sandmann W. Duplex ultrasound findings before and after surgery in children and adolescents with renovascular hypertension. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2786-2793. [PMID: 25308948 DOI: 10.1016/j.ultrasmedbio.2014.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/07/2014] [Accepted: 07/16/2014] [Indexed: 06/04/2023]
Abstract
We report our experience with duplex ultrasound in young patients with renal artery stenosis (RAS) or middle aortic syndrome (MAS) before and after surgery (1995 and 2009). Of 36 patients (mean age: 13 ± 7 y), 21 had RAS and 15 had MAS. For patients with RAS, the Vmax in the affected artery was 350 ± 111 cm/s before surgery and 145 ± 55 cm/s after surgery. The resistance index was 0.46 ± 0.1 in the post-stenotic kidney and increased to 0.60 ± 0.08 after revascularization. Determination of the flow profile in the iliac artery revealed triphasic flow. In individuals with MAS, Vmax in the aorta was 323 ± 98 and the resistance index in both kidneys was low, even in the absence of RAS. The flow profile in the iliac arteries was monophasic before surgery and became triphasic after surgery. Duplex ultrasound is useful for the evaluation of children and young adults both pre- and post-surgery. Duplex ultrasound criteria for RAS in adults appear to be applicable in children and young adults also. The diagnostic evaluation of suspected renal vascular disease should include assessment of the aorta and the flow profile in the iliac arteries, as this could help differentiate between aortic and isolated renal artery stenosis.
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Affiliation(s)
- Adina Voiculescu
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; Nephrology Department, University Hospital Dusseldorf, Dusseldorf, Germany.
| | - Andreas Heusch
- Paediatric Cardiology and Pulmonary Medicine, Helios Klinikum Wuppertal, Wuppertal, Germany
| | - Philip Düppers
- Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany
| | - Siamak Pourhassan
- Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany
| | - Dirk Klee
- Diagnostic and Interventional Radiology, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Lars C Rump
- Nephrology Department, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Wilhelm Sandmann
- Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany
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Cha SD, Chisolm DJ, Mahan JD. Essential pediatric hypertension: defining the educational needs of primary care pediatricians. BMC MEDICAL EDUCATION 2014; 14:154. [PMID: 25063988 PMCID: PMC4124498 DOI: 10.1186/1472-6920-14-154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/17/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND In order to better understand the educational needs regarding appropriate recognition, diagnosis and management of pediatric hypertension (HTN), we asked practicing pediatricians questions regarding their educational needs and comfort level on this topic. METHODS We conducted 4 focus group sessions that included 27 participants representing pediatric residents, adolescent medicine physicians, clinic based pediatricians and office based pediatricians. Each focus group session lasted for approximately an hour and 90 pages of total transcriptions were produced verbatim from audio recordings. RESULTS Four reviewers read each transcript and themes were elucidated from these transcripts. Overall, 5 major themes related to educational needs and clinical concerns were found: utilization of resources to define blood pressure (BP), correct BP measurement method(s), co-morbidities, barriers to care, and experience level with HTN. Six minor themes were also identified: differences in BP measurement, accuracy of BP, recognition of HTN, practice pattern of care, education of families and patients, and differences in level of training. The focus group participants were also questioned on their preferences regarding educational methods (i.e. e-learning, small group sessions, self-study, large group presentations) and revealed varied teaching and learning preferences. CONCLUSIONS There are multiple methods to approach education regarding pediatric HTN for primary care pediatricians based on provider preferences and multiple educational activities should be pursued to achieve best outcomes. Based on this data, the next direction will be to develop and deliver multiple educational methods and to evaluate the impact on practice patterns of care for children and adolescents with HTN.
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Affiliation(s)
- Stephen D Cha
- Pediatric Nephrology, Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Deena J Chisolm
- The Ohio State University College of Medicine, Columbus, OH, USA
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - John D Mahan
- Pediatric Nephrology, Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
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Epidemiology of Secondary Hypertension in Children. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Renal sonography with Doppler for detecting suspected pediatric renin-mediated hypertension - is it adequate? Pediatr Radiol 2014; 44:42-9. [PMID: 24037085 DOI: 10.1007/s00247-013-2785-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 07/18/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Renal Doppler US is used to evaluate suspected vascular causes of hypertension in children, despite mostly unknown diagnostic performance characteristics. OBJECTIVE To evaluate renal Doppler US for detecting vascular causes of hypertension in children with high clinical suspicion of aortic or renal artery narrowing. MATERIALS AND METHODS We identified pediatric renal Doppler US examinations performed for hypertension between January 1995 and June 2010 at our institution. We excluded children without follow-up angiography (CT-, MR-, or catheter-based). Two pediatric radiologists reviewed imaging studies and documented relevant findings. Intrarenal spectral Doppler resistive index measurement <0.5 or tardus parvus waveform constituted a positive examination. RESULTS Thirty-five boys and 13 girls underwent renal Doppler US and confirmatory imaging (mean age = 9.0 years). Nineteen US examinations were truly negative, two were falsely negative, 18 were truly positive (16 involved narrowing of the aorta or main renal artery) and nine were falsely positive. Sonography had a sensitivity and specificity of 90% and 68%, respectively, for detecting a vascular cause of hypertension. CONCLUSION Renal Doppler sonography reliably detects renin-mediated hypertension caused by aortic or main renal artery narrowing in children. More studies are needed to determine its ability to detect intrarenal and accessory renal artery stenoses.
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Hypertension associated with coarctation of the aorta revisited: case-based update from experience of three children. Case Rep Pediatr 2013; 2013:716438. [PMID: 24093067 PMCID: PMC3777203 DOI: 10.1155/2013/716438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 08/07/2013] [Indexed: 11/17/2022] Open
Abstract
Coarctation of the aorta (CoA) can present with different clinical pictures depending on the severity of the narrowness in the coarcted aortic segment in an age range between newborn and adolescence. Sometimes, it can cause intracranial hemorrhage or infarction when diagnosis and treatment are delayed. The aim of this report is taking attention to CoA as a cause of systemic hypertension and is also emphasizing the differences of diagnostic approach for hypertension in children from adults. Two cases of hypertensive cerebral hemorrhage and one case of hypertensive cerebellar infarction associated with CoA are reported. These cases help us to pay attention to the possibility of CoA in adolescents with hypertensive stroke. We want to emphasize the importance of physical examination for evaluation of hypertension and to impress the diagnostic approach for secondary hypertension in children.
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Flynn J, Zhang Y, Solar-Yohay S, Shi V. Clinical and demographic characteristics of children with hypertension. Hypertension 2012; 60:1047-54. [PMID: 22892814 DOI: 10.1161/hypertensionaha.112.197525] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Most information describing hypertension in the young comes from single-center reports. To better understand contemporary demographic and clinical characteristics of hypertensive children and adolescents, we examined baseline data on 351 children aged 1 to <17 years old who were enrolled in 2 multicenter trials of valsartan. Anthropometric, laboratory, and demographic information at randomization was extracted from the clinical trials databases. Summary variables were created and compared for 3 age groups: <6 years (n=90), 6 to <12 years (n=131), and 12 to <17 years (n=130). Comparisons were also made between different etiologies of hypertension and for different anthropometric categories. Children<6 years old were significantly more likely to have secondary hypertension and were significantly less likely to have weight or body mass index>95 percentile compared with older children. Estimated glomerular filtration rate was significantly lower in children<6 years old (90.9±31.8 mL/min per 1.73 m2) than in the other 2 age groups (6 to <12 years, 141.4±42.1 mL/min per 1.73 m2; 12 to <17 years, 138.3±46.0 mL/min per 1.73 m2). Frequency of total cholesterol>95 percentile was significantly lower in children aged<6 years. Diastolic blood pressure index (subject blood pressure÷95 percentile) was significantly higher in children<6 years old (1.1 versus 1.0 in both the 6 to <12 years and 12 to <17 years groups; both P<0.0001). We conclude that hypertensive children<6 years are more likely to have secondary hypertension and to have higher diastolic blood pressure and lower glomerular filtration rate and are less likely to be obese or to have elevated cholesterol than school-aged children or adolescents. These findings emphasize unique aspects of childhood hypertension that should be considered when evaluating children and adolescents with elevated blood pressure and in designing future clinical trials.
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Affiliation(s)
- Joseph Flynn
- Division of Nephrology, A-7931, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Szmigielska A, Roszkowska-Blaim M, Werner B, Kamińska H, Brzewski M. Hypertension in a girl with severe coarctation of the aorta and renal agenesis. J Pediatr 2012; 160:705-6. [PMID: 22082948 DOI: 10.1016/j.jpeds.2011.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 10/04/2011] [Indexed: 10/15/2022]
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Quirino IG, Diniz JSS, Bouzada MCF, Pereira AK, Lopes TJ, Paixão GM, Barros NN, Figueiredo LC, Cabral ACV, Simões e Silva AC, Oliveira EA. Clinical course of 822 children with prenatally detected nephrouropathies. Clin J Am Soc Nephrol 2012; 7:444-51. [PMID: 22266574 DOI: 10.2215/cjn.03400411] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest. RESULTS Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P<0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P<0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P<0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P<0.001). CONCLUSIONS In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.
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Affiliation(s)
- Isabel G Quirino
- Pediatric Nephrology Unit, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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