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Investigation of Hypertension in Childhood

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Pediatric Kidney Disease

Abstract

The rational investigation of hypertension requires careful attention in pediatric nephrology. Hypertensive children are more likely to suffer from a specific underlying disease than adults and are at greater risk of long-term target-organ damage, but should not be subjected to unnecessary diagnostic procedures. However, the investigation of pediatric hypertension poses numerous practical and scientific problems in three main areas: measuring blood pressure, defining hypertension and deciding about the extent of further investigations in the hypertensive patient. The changing cardiovascular physiology, pathology and body dimensions in childhood add complexity in each of these areas. This chapter deals first with the different techniques for measuring blood pressure with their respective advantages and pitfalls. Subsequently, the current definitions of hypertension are discussed, including the pediatric population distribution based approach to normal blood pressure ranges. For each method the availability and usefulness of normal values is presented. Finally, we give a guide to the initial and follow up investigation of the hypertensive child, with a discussion of established and novel diagnostic tests as well as markers of target organ damage.

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Abbreviations

ABPM:

Ambulatory blood pressure monitoring

ACE:

Angiotensin converting enzyme

BHS:

British Hypertension Society

BMI:

Body mass index

BP:

Blood pressure

ESH:

European Society of Hypertension

IMT:

Intima media thickness

JNC:

Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure

LVH:

Left ventricular hypertrophy

MAP:

Mean arterial pressure

PRA:

Plasma renin activity

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Authors and Affiliations

  1. Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center – University of Freiburg, Mathildenstr.1, Freiburg, 79106, Germany

    Charlotte Gimpel

  2. Division of Pediatric Nephrology, Heidelberg University Center for Pediatrics and Adolescent Medicine, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany

    Elke Wühl

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  1. Charlotte Gimpel
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  2. Elke Wühl
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Correspondence to Charlotte Gimpel .

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Editors and Affiliations

  1. Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada

    Denis F. Geary

  2. Division of Pediatric Nephrology, University of Heidelberg, Heidelberg, Germany

    Franz Schaefer

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Gimpel, C., Wühl, E. (2016). Investigation of Hypertension in Childhood. In: Geary, D., Schaefer, F. (eds) Pediatric Kidney Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52972-0_50

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