Concepts guiding therapy for hypertension in children

A longitudinal study on the catch-up growth of preterm and term infants of low, appropriate, and high birth weight

The purpose of present study was to explore the trajectories of growth of preterm and term infants of low, high, and appropriate birth weight. A total of 2465 infants were recruited from 2005 to 2007. Infants' length and weight were measured at 12 points: birth, 42 days, and monthly from 3 to 12 months. The catch-up growth of preterm infants, measured by weight or length of chronological age, occurred from 10th or 12th month of their lives. After adjusted gestational age, preterm infants' weight and length were caught-up from the adjusted birthday, overweight/over-length even occurred from 10th/11th month. For low birth weight term infants, catch-up growth was not found when using single weight or length. The ponderal index catch-up growth occurred earlier than measured by single weight or length. The catch-down growth of high birth weight term infants was not found in the first year of their lives.

Therapeutic options for the treatment of hypertension in children and adolescents

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%-5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies.

Hypertension in children and adolescents

Pediatric hypertension (HTN) has become the focus of interest recently due to its increasing prevalence. This is mainly related to the increase in childhood obesity, although the current evidence suggests that other lifestyle factors, apart from obesity, contribute to high blood pressure (BP) in childhood. Traditionally, office BP measurements by the physician have been the cornerstone for the assessment of HTN in children. However, since the white coat and masked HTN phenomena are not rare in childhood, out-of-office BP measurements have significantly improved the accurate diagnosis of HTN and decision making. Ambulatory BP monitoring is regarded as indispensable for the evaluation of pediatric HTN, providing details not only for the staging for HTN, but also for the study of other ambulatory BP patterns. It should be pointed out that HTN in children and adolescents is associated with target-organ damage which is significant in terms of cardiovascular risk. The current knowledge, outlined in the present review, is expected to help in early and accurate diagnosis as well as in the management of HTN in children and adolescents.

Can we predict hypertension among preterm children?

Prematurity and low birth weight (LBW) cause hypertension (HTN), ischemic heart disease, and obesity in young adults. The objective of the study was to identify risk factors for the development of HTN in children born preterm or at a LBW and to assess pediatricians' awareness of the problem. A retrospective review of 160 cases was conducted. In total, 22% of babies born preterm/LBW developed HTN by age 15 years. The odds of developing HTN were 1.6 times greater for every one standard deviation increase in body mass index. Higher risk posses for those born small for gestational age and under 1000 g. Of the 35 cases of HTN identified, only 31% were recognized as abnormal by the primary care providers. The development of obesity and HTN appear related in preterm/LBW children. Awareness of prematurity or LBW as a risk factor for HTN should be raised among pediatric primary care providers.

Assessment and management of hypertension in children and adolescents

The epidemic of overweight and obesity in youth is increasing the prevalence of prehypertension and hypertension among children and adolescents. The younger the child is at presentation and the more severe the blood pressure abnormality, the more likely a secondary cause of hypertension is to be present. Measurement of blood pressure in children requires adaptation to the age and size of the child. Interpretation must be related to normative values specific for age, sex, and height. Evaluation is primarily aimed at identifying secondary causes of hypertension, associated comorbidities, additional risk factors, and evidence of target-organ damage. Ambulatory blood pressure monitoring is emerging as a useful tool for evaluation of some patients, particularly for those with suspected 'white coat' hypertension. Management of prehypertension and hypertension is directed at the underlying cause, exacerbating factors, and the magnitude of the blood pressure abnormality. Healthy behavioral changes are a primary management tool for treating hypertension and, more particularly, prehypertension and for addressing other cardiovascular risk factors, such as obesity. Pharmacological management is reserved for patients with hypertension who do not respond to behavioral changes, have additional cardiovascular risk factors or diabetes, are symptomatic, or have developed target-organ damage.