Hypertension in Children

Clinical Description

Refer all children with hypertension to a doctor for management

• In children, hypertension is defined statistically because BP levels vary with age and outcome. Based data are not available for this population. Hypertension is defined as systolic and /or diastolic pressure levels greater than the 95th percentile for age and gender on at least 3 occasions
• The upper limit for normal systolic Bp in children greater than 0one year may be calculated as follows:

o (Age in years x 3) +100

• Diastolic BP is 2/3 of systolic BP o 90% of hypertension in children is caused by renal conditions

The table below shows normative blood pressure levels (systolic/diastolic) in children up to age 5 years. Blood pressures above the 95th percentile indicate hypertension

Age Mean BP levels 95th Percentile 1-3 days 64/41 (50) 78/52 (62) 1mo -2yr 95/58 (72) 110/71 (86) 2-5yr 101/57 (74) 115/68 (85)

Remember to use the correct cuff size when measuring BP. It should cover 2/3 of the upper arm

Primary hypertension

• Idiopathic

Secondary hypertension

Renal disease

• Renal parenchymal disease: glomerulonephritis
• polycystic kidney disease
• congenital abnormalities of kidney and urinary tract,
• chronic kidney disease

Renovascular disease

• Renal artery stenosis
• Takayasu arteritis

Endocrine

• Pheochromocytoma
• Agangliomas
• Hyperthyroidism
• Cushing’s syndrome

Cardiac

• Coarctation of the aorta

Drugs

• Steroids

Tumors

• Wilm’s tumor
• neuroblastoma
• adrenal carcinoma

Signs and Symptoms

• seizures, claudication, sweating, headache, tachycardia, altered level of consciousness, signs of underlying condition

Investigations

• limb BP, Urine dipstick and urinalysis, Urea, electrolytes, and creatinine, FBC, Abdominal ultrasound scan and doppler, ECG, Echocardiography, Fundoscopy, rest of investigations dependent on underlying cause

Non-pharmacological

• Reduce salt intake
• Regular monitored exercise
• Weight loss

Pharmacological

• 1. Calcium channel blocker
• a. Nifedipine slow release 0.1-0.25mg/kg 6 hourly PO or
• b. Amlodipine 0.1mg/kg 4 to 6 hourly PO
• 2. ACE-Inhibitor
• a. Enalapril 0.1mg/kg PO daily or 12 hourly or
• b. Lisinopril 0.1mg/kg PO daily
• 3. Beta Blockers
• a. Propranolol 0.5-1mg/kg 12 hourly

Complications

• Hypertensive crises
• Hypertensive retinopathy
• Hypertensive nephropathy
• Hypertensive cardiomyopathy

Complications and Referral Criteria

Refer all children with hypertension for diagnostic work up