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Pediatric Hypertension: Impact on the Heart, Brain, Kidney, and Retina

  • Pediatrics
  • Published:
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Abstract

Purpose of Review

Pediatric hypertension is increasing in incidence with concomitant increases in childhood obesity. Target organ damage from primary or secondary pediatric hypertension is a growing concern, as the pathogenesis of vascular disease, typically observed later in life, may begin at a young age. While hypertensive complications are described extensively in adults, much less is known about end organ damage from elevated blood pressure in children and adolescents.

Recent Findings

This review highlights the recent advances describing the target organ damage in the macro- and microvasculature resulting from hypertension. Persistently elevated blood pressure in childhood is associated with vascular changes affecting the heart, brain, kidneys, and retina. Emerging research shows that elevated blood pressure in children has effect on neurocognitive function in specific domains such as executive functioning, attention, and memory. Microalbuminuria is an early marker of kidney disease and a sign of glomerular injury and endothelial dysfunction that increases the risk of kidney damage and is associated with future kidney and cardiovascular events. Screening with ambulatory blood pressure monitoring to improve blood pressure control and echocardiogram may aid in early prevention of end organ damage.

Summary

In this review, we summarize and critically evaluate recent findings, describe ongoing studies, and address future research questions. Implications for diagnosis, prognosis, and need for better control of hypertension are also discussed.

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Author notes

  1. JVR and SZH contributed equally as lead authors.

Authors and Affiliations

  1. Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada

    Jovanka Vasilevska-Ristovska, Shawn Z. Hudes, Kirtiga Naguleswaran & Rulan S. Parekh

  2. Graduate Entry Medical School, University of Limerick, Limerick, Ireland

    Shawn Z. Hudes

  3. Royal College of Surgeons in Ireland, Dublin 2, Ireland

    Kirtiga Naguleswaran

  4. Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Canada

    Valerie Langlois, Mina Matsuda-Abedini & Rulan S. Parekh

  5. Department of Paediatrics, University of Toronto, Toronto, Canada

    Valerie Langlois, Mina Matsuda-Abedini & Rulan S. Parekh

  6. Division of Nephrology, University Health Network, Toronto, Canada

    Rulan S. Parekh

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  1. Jovanka Vasilevska-Ristovska
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Jovanka Vasilevska-Ristovska, Shawn Hudes, Kirtiga Naguleswaran, Valerie Langlois, Mina Matsuda-Abedini, and Rulan Parekh declare that they have no conflict of interest.

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Vasilevska-Ristovska, J., Hudes, S.Z., Naguleswaran, K. et al. Pediatric Hypertension: Impact on the Heart, Brain, Kidney, and Retina. Curr Cardiovasc Risk Rep 12, 14 (2018). https://doi.org/10.1007/s12170-018-0577-6

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