Abstract :
Absolute levels of blood pressure which define hypertension differ in childhood compared to adult criteria. Extensive epidemiological data on growth and blood pressure in children and adolescents now provide values for a normal range of blood pressure throughout childhood. Hypertension in the young is defined as systolic or diastolic blood pressure which is repeatedly > the 95th percentile for age. Regular measurement of BP and use of these reference values enable accurate detection of hypertension in both symptomatic and asymptomatic children and adolescents. When hypertension is confirmed by repeated BP measurement, decisions must be made regarding further evaluation for detection of a possible underlying cause for the hypertension. In general, the younger the child and the higher the BP, the more likely that a secondary cause for the hypertension will be identified. Unilateral and bilateral renal disease, renal-vascular disease, and coarctation of the aorta are leading causes of severe secondary hypertension in childhood and are often correctable. Mild degrees of hypertension in the young may also be due to early expression of primary hypertension. In children and adolescents, essential hypertension is characterized by BP variability, a family history of hypertension, and frequently obesity. Pharmacologic therapy to control significant and severe hypertension is indicated for cardiovascular and renal protection. When early essential hypertension is the likely diagnosis in children or adolescents with mild BP elevation, emphasis is directed at life-style modification including diet, weight control, and physical activity to control hypertension risk factors.
