Hypertension in young children and neonates

  • John Edward Jones
  • Pedro A. Jose


Hypertension is most often considered a disease of old age, but the precursors are often present in young children long before the clinically accepted definitions of hypertension in the adult are manifested. Essential hypertension is by far the most common form of the disease, comprising a complex interaction of genetic and environmental factors. Many individual genes that play a role in the maintenance of blood pressure have been identified; however, none has been shown specifically to be a component of essential hypertension. Hypertension is among the leading risk factors for coronary heart disease, stroke, and end-stage renal disease, making it critically important to identify individuals at risk early in life prior to manifestation of clinical signs and symptoms.

References and Recommended Reading

  1. 1.
    The Pan American Hypertension Initiative (PAHI) Mission: http://www.meduohio.edu/org/whl/pahi.html. Accessed June 24, 2005.Google Scholar
  2. 2.
    Lifton RP: Molecular genetics of human blood pressure variation. Science 1996, 272:676–680.PubMedCrossRefGoogle Scholar
  3. 3.
    Staessen JA, Wang J, Bianchi G, et al.: Essential hypertension. Lancet 2003, 361:1629–1641.PubMedCrossRefGoogle Scholar
  4. 4.
    Andersson OK, Almgren T, Persson B, et al.: Survival in treated hypertension: follow up study after two decades. BMJ 1998, 317:167–171.PubMedGoogle Scholar
  5. 5.
    Luft FC: Hypertension as a complex genetic trait. Semin Nephrol 2002, 22:115–126.PubMedCrossRefGoogle Scholar
  6. 6.
    Snieder H, Harshfield GA, Treiber FA: Heritability of blood pressure and hemodynamics in African- and European-American youth. Hypertension 2003, 41:1196–1201.PubMedCrossRefGoogle Scholar
  7. 7.
    Onusko E: Diagnosing secondary hypertension. Am Fam Physician 2003, 67:67–74.PubMedGoogle Scholar
  8. 8.
    Jones JE, Jose PA: Neonatal blood pressure regulation. Semin Perinatol 2004, 28:141–148.PubMedCrossRefGoogle Scholar
  9. 9.
    Flynn JT: Neonatal hypertension: diagnosis and management. Pediatr Nephrol 2000, 14:332–341.PubMedCrossRefGoogle Scholar
  10. 10.
    Abman SH, Warady BA, Lum GM, Koops BL: Systemic hypertension in infants with bronchopulmonary dysplasia. J Pediatr 1984, 104:929–931.Google Scholar
  11. 11.
    Androgué HE, Sinaiko AR: Prevalence of hypertension in junior high school-aged children: effect of new recommendations in the 1996 updated Task Force Report. Am J Hypertens 2001, 14:412–414.CrossRefGoogle Scholar
  12. 12.
    Varda NM, Gregoric A: A diagnostic approach for the child with hypertension. Pediatr Nephrol 2005, 20:499–506.PubMedCrossRefGoogle Scholar
  13. 13.
    Berenson GS: Childhood risk factors predict adult risk associated with subclinical cardiovascular disease: the Bogalusa heart study. Am J Cardiol 2002, 90(Suppl):3L-7L.PubMedCrossRefGoogle Scholar
  14. 14.
    Sorof J, Daniels S: Obesity hypertension in children: a problem of epidemic proportions. Hypertension 2002, 40:441–447. A brief review of the impact of obesity-related hypertension in children. Describes the pathophysiology and cardiovascular risk factors and complications associated with the disorder.PubMedCrossRefGoogle Scholar
  15. 15.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004, 114:555–576. An important consensus statement that reviews the current status of the diagnosis and evaluation of hypertension in children. Includes revised tables of blood pressure standards that account for the normal changes in blood pressure based on sex, age, and height that occur during childhood to facilitate the precise categorization of blood pressure relative to body size.CrossRefGoogle Scholar
  16. 16.
    National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents: Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 1996, 98:649–658.Google Scholar
  17. 17.
    Centers for Disease Control and Prevention, National Center for Health Statistics: 2000 CDC growth charts: United States. http://www.cdc.gov/growthcharts. Accessed July 1, 2005.Google Scholar
  18. 18.
    Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.PubMedCrossRefGoogle Scholar
  19. 19.
    Sorof JM, Portman RJ: Ambulatory blood pressure monitoring in the pediatric patient. J Pediatr 2000, 136:578–586.PubMedCrossRefGoogle Scholar
  20. 20.
    Pickering TG, Davidson K, Gerin W, Schwartz JE: Masked hypertension. Hypertension 2002, 40:795–796.PubMedCrossRefGoogle Scholar
  21. 21.
    Matsuoka S, Awazu M: Masked hypertension in children and young adults. Pediatric Nephrol 2004, 19:651–654.CrossRefGoogle Scholar
  22. 22.
    Barker DJ: The fetal origins of hypertension. J Hypertens Suppl 1996, 14:S117-S120.PubMedGoogle Scholar
  23. 23.
    Lucas A, Fewtrell MS, Cole TJ: Fetal origins of adult disease: the hypothesis revisited. BMJ 1999, 319:245–249.PubMedGoogle Scholar
  24. 24.
    Huxley R, Neil A, Collins R: Unravelling the fetal origins hypothesis: Is there really an inverse association between birth weight and subsequent blood pressure? Lancet 2002, 360:659–665.PubMedCrossRefGoogle Scholar
  25. 25.
    Lawlor DA, Davey Smith G: Early life determinants of adult blood pressure. Curr Opin Nephrol Hypertens 2005, 14:259–264.PubMedCrossRefGoogle Scholar
  26. 26.
    Meneton P, Jeunemaitre X, de Wardener HE, Macgregor GA: Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev 2005, 85:679–715.PubMedCrossRefGoogle Scholar
  27. 27.
    Sullivan JM: Salt sensitivity. Definition, conception, methodology, and long-term issues. Hypertension 1991, 17(1 Suppl) I61-I68.PubMedGoogle Scholar
  28. 28.
    de Wardener HE, MacGregor GA: Harmful effects of dietary salt in addition to hypertension. J Hum Hypertens 2002, 16:213–223.PubMedCrossRefGoogle Scholar
  29. 29.
    Tobian L, Hanlon S: High sodium chloride diets injure arteries and raise mortality without changing blood pressure. Hypertension 1990, 15:900–903.PubMedGoogle Scholar
  30. 30.
    Bagrov AY, Lakatta EG: The dietary sodium-blood pressure plot “stiffens.” Hypertension 2004, 44:22–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Boddi M, Poggesi L, Coppo M, et al.: Human vascular reninangiotensin system and its functional changes in relation to different sodium intakes. Hypertension 1998, 31:836–842.PubMedGoogle Scholar
  32. 32.
    Et-Taouil K, Schiavi P, Levy BI, Plante GE: Sodium intake, large artery stiffness, and proteoglycans in the spontaneously hypertensive rat. Hypertension 2001, 38:1172–1176.PubMedGoogle Scholar
  33. 33.
    Weinberger MH, Fineberg NS, Fineberg SE, Weinberger M: Salt sensitivity, pulse pressure, and death in normal and hypertensive humans. Hypertension 2001, 37:429–432.PubMedGoogle Scholar
  34. 34.
    Alderman MH: Dietary sodium and cardiovascular health in hypertensive patients: the case against universal sodium restriction. J Am Soc Nephrol 2004, 15(Suppl 1):S47-S50.PubMedCrossRefGoogle Scholar
  35. 35.
    Ruiz-Opazo N, Lopez LV, Tonkiss J: Modulation of learning and memory in Dahl rats by dietary salt restriction. Hypertension 2004, 43:797–802.PubMedCrossRefGoogle Scholar
  36. 36.
    Jones DW: Dietary sodium and blood pressure. Hypertension 2004, 43:932–935.PubMedCrossRefGoogle Scholar
  37. 37.
    Ogden CL, Troiano RP, Briefel RR, et al.: Prevalence of overweight among preschool children in the United States, 1971 through 1994. Pediatrics 1997, 99:E1.PubMedCrossRefGoogle Scholar
  38. 38.
    Steinberger J, Daniels SR: Obesity, insulin resistance, diabetes and cardiovascular risk in children. An American Heart Association Scientific Statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation 2003, 107:1448–1453.PubMedCrossRefGoogle Scholar
  39. 39.
    Dekkers JC, Snieder H, van den Oord JCG, Treiber FA: Moderators of blood pressure development from childhood to adulthood: a 10-year longitudinal study. J Pediatr 2002, 141:770–779.PubMedCrossRefGoogle Scholar
  40. 40.
    Manatunga AK, Jones JJ, Pratt JH: Longitudinal assessment of blood pressures in black and white children. Hypertension 1993, 22:84–89.PubMedGoogle Scholar
  41. 41.
    Dominiczak AF, Brain N, Charchar F, et al.: Genetics of hypertension: lessons learnt from Mendelian and polygenic syndromes. Clin Exp Hypertens 2004, 26:611–620.PubMedCrossRefGoogle Scholar
  42. 42.
    Lifton RP, Dluhy RG, Powers M, et al.: A chimaeric 11 betahydroxylase/ aldosterone synthase gene causes glucocorticoid-remediable aldosteronism and human hypertension. Nature 1992, 355:262–265.PubMedCrossRefGoogle Scholar
  43. 43.
    Shimkets RA, Warnock DG, Bositis CM, et al.: Liddle’s syndrome: heritable human hypertension caused by mutations in the beta subunit of the epithelial sodium channel. Cell 1994, 79:407–414.PubMedCrossRefGoogle Scholar
  44. 44.
    Wilson FH, Disse-Nicodeme S, Choate KA, et al.: Human hypertension caused by mutations in WNK kinases. Science 2001, 293:1107–1112.PubMedCrossRefGoogle Scholar
  45. 45.
    Stewart PM, Corrie JE, Shackleton CH, Edwards CR: Syndrome of apparent mineralocorticoid excess: a defect in the cortisolcortisone shuttle. J Clin Invest 1988, 82:340–349.PubMedCrossRefGoogle Scholar
  46. 46.
    Gellar DS, Farhi A, Pinkerton N, et al.: Activating mineralocorticoid receptor mutation in hypertension exacerbated by pregnancy. Science 2000, 289:119–123.CrossRefGoogle Scholar
  47. 47.
    Shuster H, Wienker TE, Bahring S, et al.: Severe autosomal dominant hypertension and brachydactyly in a unique Turkish kindred maps to human chromosome 12. Nat Genet 1996, 13:98–100.CrossRefGoogle Scholar
  48. 48.
    Beeks E, Kessels AGH, Kroon AA, et al.: Genetic predisposition to salt-sensitivity: a systematic review. J Hypertens 2004, 22:1243–1249.PubMedCrossRefGoogle Scholar
  49. 49.
    Poch E, González D, Giner V, et al.: Molecular basis of salt sensitivity in human hypertension. Hypertension 2001, 38:1204–1209.PubMedGoogle Scholar
  50. 50.
    Rao DC, Province MA, Leppert MF, et al.: A genome-wide affected sibpair linkage analysis of hypertension: the Hyper-GEN network. Am J Hypertens 2003, 16:148–150.PubMedCrossRefGoogle Scholar
  51. 51.
    Thiel BA, Chakravarti A, Cooper RS, et al.: A genome-wide linkage analysis investigating the determinants of blood pressure in whites and African Americans. Am J Hypertens 2003, 16:151–153.PubMedCrossRefGoogle Scholar
  52. 52.
    Kardia SLR, Rozek LS, Krushkal J, et al.: Genome-wide linkage analysis for hypertension genes in two ethnically and geographically diverse populations. Am J Hypertens 2003, 16:154–157.PubMedCrossRefGoogle Scholar
  53. 53.
    Ranade K, Hinds D, Hsiung CA, et al.: A genome scan for hypertension susceptibility loci in populations of Chinese and Japanese origins. Am J Hypertens 2003, 16:158–162.PubMedCrossRefGoogle Scholar
  54. 54.
    Caulfield M, Munroe P, Pembroke J, et al.: Genome-wide mapping of human loci for essential hypertension. Lancet 2003, 361:2118–2123.PubMedCrossRefGoogle Scholar
  55. 55.
    Liu W, Zhao W, Chase GA: Genome scan meta-analysis for hypertension. Am J Hypertens 2004, 17:1100–1106.PubMedCrossRefGoogle Scholar
  56. 56.
    Samani NJ: Genome scans for hypertension and blood pressure regulation. Am J Hypertens 2003, 16:167–171.PubMedCrossRefGoogle Scholar
  57. 57.
    Glazier AM, Nadeau JH, Aitman TJ: Finding genes that underlie complex traits. Science 2002, 298:2345–2349.PubMedCrossRefGoogle Scholar
  58. 58.
    Bengra C, Mifflin TE, Khripin Y, et al.: Genotyping essential hypertension SNPs using a homogenous PCR method with universal energy transfer primers. Clin Chem 2002, 48:2131–2140.PubMedGoogle Scholar
  59. 59.
    Speirs HJ, Katyk K, Kumar NN, et al.: Association of G-proteincoupled receptor kinase 4 haplotypes, but not HSD3B1 or PTP1B polymorphisms, with essential hypertension. J Hypertens 2004, 22:931–936.PubMedCrossRefGoogle Scholar
  60. 60.
    Zeng C, Sanada H, Watanabe H, et al.: Functional genomics of the dopaminergic system in hypertension. Physiol Genomics 2004, 19:233–246.PubMedCrossRefGoogle Scholar
  61. 61.
    Felder RA, Sanada H, Xu J, et al.: G protein-coupled receptor kinase 4 gene variants in human essential hypertension. Proc Natl Acad Sci USA 2002, 99:3872–3877.PubMedCrossRefGoogle Scholar
  62. 62.
    Sanada H, Yatabe J, Yoneda M, et al.: In vivo targeting of the renal G protein-coupled receptor kinase type 4 (GRK4) with antisense oligonucleotides induces natriuresis in spontaneously hypertensive rats. Circulation 2002, 106(Suppl II):II-234.Google Scholar
  63. 63.
    Williams SM, Ritchie MD, Phillips III JA, et al.: Multilocus analysis of hypertension: a hierarchical approach. Hum Hered 2004, 57:28–38. A demonstration of the use of multilocus analysis in hypertension. Illustrates the role played by epistatic interactions in hypertension susceptibility.PubMedCrossRefGoogle Scholar
  64. 64.
    Bianchi G, Ferrari P, Staessen JA: Adducin polymorphism: detection and impact on hypertension and related disorders. Hypertension 2005, 45:331–340.PubMedCrossRefGoogle Scholar
  65. 65.
    Stoll M, Kwitek-Black AE, Cowley AW Jr, et al.: New target regions for human hypertension via comparative genomics. Genome Res 2000, 10:473–482.PubMedCrossRefGoogle Scholar
  66. 66.
    Sugiyama F, Churchill GA, Li R, et al.: QTL associated with blood pressure, heart rate, and heart weight in CBA/CaJ and BALB/cJ mice. Physiol Genomics 2002, 10:5–12.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • John Edward Jones
    • 1
  • Pedro A. Jose
    • 1
  1. 1.Department of Pediatrics and Physiology and BiophysicsGeorgetown University Medical CenterWashington, DCUSA

Personalised recommendations