Hypertension in Children

Prevalence of hypertension (HT) in children is increasing. Part of the reason is the rise in the population of children with obesity and part is better screening for HT though far from ideal. Neonatal and infantile HT remains relatively poorly described in terms of epidemiology, normative data, and available antihypertensive medications. The 2017 American Academy of Pediatrics guidelines on the management of HT in children have used data from children with normal body mass index thereby lowering the cutoffs for definition of HT compared to earlier. HT is now staged as elevated, Stage 1 and Stage 2, making earlier terminologies obsolete. Elevated blood pressure (BP) is important as studies show that an elevated BP as a child increases risk of developing HT as an adult as well as metabolic syndrome. Ambulatory BP monitoring in pediatrics is increasingly being used in various situations though so far there is no normative data for children <120 cm in height. Investigations into the cause of HT may be limited when the patient is over 6 years of age and is overweight or obese or has family history of HT and the physical examination is normal. The two major causes of secondary HT in pediatrics are renal/reno-vascular and endocrine. Lifestyle modification plays a major role in therapy. It includes weight reduction/control by increasing physical activity, nutritious, and low-fat diet and reducing salt intake. The first-line medications for oral therapy are angiotensin converting enzyme inhibitors, angiotensin receptor blockers, thiazide diuretics, and calcium channel blockers. Lifelong follow-up is essential for care of the pediatric patient with HT.