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Hypertension in the Young

  • Suzanne Oparil

Abstract

Detection and management of hypertension in children and adolescents are made difficult by the lack of generally agreed-upon diagnostic criteria for abnormally elevated blood pressure, by the lability of blood pressure in this age group, and by our lack of experience with both pharmacologic and non-pharmacologic management of hypertension in the young. Despite the widespread view that primary hypertension may begin in childhood, it is frequently not possible to determine in any given case whether blood pressure increments that occur with growth are physiological or represent the origins of hypertension that will develop fully in adulthood. During normal childhood and adolescence, blood pressure increases as a result of growth and maturation [1,2] and is so heavily dependent on age that a nomogram of blood pressure versus age must be used to define the normal range.

Keywords

Renal Artery Essential Hypertension Renal Artery Stenosis Congenital Adrenal Hyperplasia Renovascular Hypertension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Harlan, W.R.; Cornoni-Huntley, J.; and Leaverton, P.E. 1979. Blood pressure in childhood: The National Health Examination Survey, Hypertension 1: 559–565.PubMedGoogle Scholar
  2. 2.
    Cornoni-Huntley, J.; Harlan, W.R.; and Leaverton, P.E. 1979. Blood pressures in adolescence: The United States Health Examination Survey. Hypertension 1: 566–571.PubMedGoogle Scholar
  3. 3.
    Blumenthal, S.; Epps, R.P.; Heavenrich, R.; Laar, R.M.; Leiberman, E.; Mirkin, B.; Mitchell, S.C.; Naito, V.B.; O’Hare, D.; Smith, W.M.; Tarazi, R.; and Upson, D. 1977. Report of the Task Force on Blood Pressure Control in Children. Pediatrics 59: 797–818.Google Scholar
  4. 4.
    Falkner, B.; Hamstra, B.; Lombardo, R.; and Shirk, J. 1981. Blood pressure variability in adolescent males. Int. J. Ped. Neph. 2: 177–180.Google Scholar
  5. 5.
    Katz, S.H.; Hediger, M.L.; Schall, J.I.; Bowers, E.J.; Barker, W.F.; Aurand, S.; Eveleth, P.B.; Gruskin, A.B.; and Parks, J.S. 1980. Blood pressure, growth and maturation from childhood through adolescence. Hypertension 2: 155–169.Google Scholar
  6. 6.
    Ranee, C.P.; Arbus, G.S.; Balfe, J.W.; and Kooh, S.W. 1974. Persistent systemic hypertension in infants and children. Pediatr. Clin. North. Am. 21: 801–824.Google Scholar
  7. 7.
    Gill, D.G.; DaCosta, B.M.; Cameron, J.S.; Joseph, M.C.; and Chantler, C. 1976. Analysis of 100 children with severe and persistent hypertension. Arch. Dis. Child. 51: 951–956.PubMedCrossRefGoogle Scholar
  8. 8.
    New, M.I. 1979. Report of the Hypertension Task Force: Part A, Pediatrics. U.S. Department of Health, Education and Welfare Public Health Service, NIH Publication No. 79–1628.Google Scholar
  9. 9.
    Londe, S.; Bourgoignie, J.L.; Robson, A.M.; and Goldring, D. 1971. Hypertension in apparently normal children. J. Pediatr. 78: 569–577.PubMedCrossRefGoogle Scholar
  10. 10.
    Broyer, M.; Bacri, J.L.; and Royer, P. 1981. Renal forms of hypertension in children: Report on 238 cases. In Hypertension in children and adolescents, ed. G. Giovanelli, M.I. New, and G. Gorini, pp. 201–208. New York: Raven Press.Google Scholar
  11. 11.
    Mongeau, J.G., and Fouron, J.C. 1983. Hypertension in children, including coarctation of the aorta. In Hypertension, ed. J. Genest, O. Kuchel, P. Hamet, and M. Cantin, pp. 1041–1059. New York: McGraw–Hill.Google Scholar
  12. 12.
    Reiss, M.D.; Brookstein, J.J.; and Bleifer, K.H. 1972. Radiologic aspects of renovascular hypertension. IV. Arteriography complications. JAMA 221: 374–378.CrossRefGoogle Scholar
  13. 13.
    Dillan, M.J.; Shah, V.; and Barratt, T.M. 1978. Renal vein renin measurements in children with hypertension. Br. Med. 22: 168–170.CrossRefGoogle Scholar
  14. 14.
    Re, R.; Novelline, R.; Escourrour, M.T.; Athanasoulis, C.; Burton, J.; and Haber, E. 1978. Inhibition of angiotensin-converting enzyme for diagnosis of renal-artery stenosis. N. Engl. J. Med. 298: 582–586.PubMedCrossRefGoogle Scholar
  15. 15.
    Strong, C.G.; Hunt, J.C.; Sheps, S.G.; Tucker, R.M.; and Bernatz, P.E. 1971. Renal venous renin activity: enhancement of sensitivity of lateralization by sodium depletion. Am. J. Cardiol. 27: 602–611.PubMedCrossRefGoogle Scholar
  16. 16.
    Schambelan, M.; Glickman, M.; Stockigt, J.R.; Biglieri, E.G. 1974. Selective renal-vein renin sampling in hypertensive patients with segmental renal lesions. N. Engl. J. Med. 290: 1153–1157.PubMedCrossRefGoogle Scholar
  17. 17.
    Hillman, B.J.; Ovitt, T.W.; Capp, P.; Prosnitz, E.H.; Osborne, R.W., Jr.; Goldstone, P.; Zukoski, C.F.; and Malone, J.M. 1982. The potential impact of digital video subtraction angiography on screening for renovascular hypertension. Radiology 142: 577–579.PubMedGoogle Scholar
  18. 18.
    Novick, A.C.; Buonocore, E.; and Meaney, T.F. 1982. Digital subtraction angiography for postoperative evaluation of renal arterial reconstruction. J. Urol. 127: 14–17.PubMedGoogle Scholar
  19. 19.
    Cicuto, K.P.; McLean, G.K.; Oleage, J.A.; Freiman, D.B., Grossman, R.A.; and Ring, E.J. 1981. Renal artery stenosis: anatomic classification for percutaneous transluminal angioplasty. AJR 137: 599–601.PubMedGoogle Scholar
  20. 20.
    Colapinto, R.F.; Stronell, R.D.; Harries-Jones, E.P.; Gildiner, M.; Hobbs, B.B.; Farrow, G.A.; Wilson, D.R.; Morrow, J.D.; Logan, A.G.; Birch, S.J. 1982. Percutaneous transluminal dilatation of the renal artery: follow-up studies on renovascular hypertension. AJR 139: 727–732.PubMedGoogle Scholar
  21. 21.
    Mahler, F.; Probst, P.; Haertel, M.; Weidmann, P.; and Krneta, A. 1982. Lasting improvement of renovascular hypertension by transluminal dilatation of atherosclerotic and nonatheroscle–rotic renal artery stenoses. Circulation 65: 611–617.PubMedCrossRefGoogle Scholar
  22. 22.
    Sos, T.A.; Saddekni, S.; Sniderman, K.W.; Weiner, M.; Beinart, C.; Pickering, T.G.; Case, D. B.; Vaughan, E.D., Jr.; and Laragh, J.H. 1982. Renal artery angioplasty: techniques and early results. Urol. Radiol. 3: 223–231.CrossRefGoogle Scholar
  23. 23.
    Sos, T.A.; Vaughan, E.D.; Pickering, T.G.; Case, D.; Sniderman, K.W.; Sealey, J.E.; and Laragh, J.H. 1983. Renal vascular hypertension: A. Diagnosis of renovascular hypertension and evaluation of “surgical” curability. In Transluminal angioplasty, ed. W.R. Castaneda-Zuniga, pp. 57–61. New York: Thieme-Stratton.Google Scholar
  24. 24.
    Tegtmeyer, C.J.; Brown, J.; Ayers, C.A.; Wellons, H.A.; and Stanton, L.W. 1980. Percutaneous transluminal dilatation of the renal arteries. Radiology 135: 589–599.PubMedGoogle Scholar
  25. 25.
    McCook, T.A.; Mills, S.R.; Kirks, D.R.; Heaston, D.K.; Seigler, H.F.; Malone, R.B.; and Osofsky, S.G. 1980. Percutaneous transluminal renal artery angioplasty in a 3 1/2 year old hypertensive girl. J. Pediatr. 97: 958–960.PubMedCrossRefGoogle Scholar
  26. 26.
    Sos, T.A.; Pickering, T.G.; Sniderman, K.; Saddekni, S.; Case, D.B.; Silane, M.F.; Vaughan, E. D., Jr.; and Laragh, J.H. 1983. Percutaneous transluminal renal angioplasty in renovascular hypertension due to atheroma or fibromuscular dysplasia. New Engl. J. Med. 309: 274–279.PubMedCrossRefGoogle Scholar
  27. 27.
    Makker, S.P., and Moorthy, B. 1979. Fibromuscular dysplasia of renal arteries: an important cause of renovascular hypertension in children. J. Pediatr. 95: 940–945.PubMedCrossRefGoogle Scholar
  28. 28.
    Novick, A.C.; Straffon, R.A.; Stewart, B.H.; and Benjamin, S. 1978. Surgical treatment of renovascular hypertension in the pediatric patient. J. Urol. 119: 794–799.PubMedGoogle Scholar
  29. 29.
    Franklin, S.S.; Young, J.D., Jr.; Maxwell, M.H.; Foster, J.H.; Palmer, J.M.; Cerny, J.; and Varady, P.D. 1975. Operative morbidity and mortality in renovascular disease. JAMA 231: 1148–1153.PubMedCrossRefGoogle Scholar
  30. 30.
    Conn, J. W. 1974. Primary reninism, a new syndrome. Verhandlungen der Deutschen Gesellschaft fur Innere Medizin 80: 171–182.PubMedGoogle Scholar
  31. 31.
    Alpert, B.S.; Kartodihardjo, W.; Harp, M.S.; Izukawa, T.; and Strong, W.B. 1981. Exercise blood pressure response - a predictor of severity of aortic stenosis in children. J. Pediatr. 98: 763–765.PubMedCrossRefGoogle Scholar
  32. 32.
    Connor, T.M. 1979. Evaluation of persistent coarctation of aorta after surgery with blood pressure measurement and exercise testing. Am. J. Cardiol. 43: 74–78.PubMedCrossRefGoogle Scholar
  33. 33.
    Freed, M.D.; Rocchini, A.; Rosenthal, A.; Nadas, A.S.; and Castaneda, A.R. 1979. Exercise-induced hypertension after surgical repair of coarctation of the aorta. Am. J. Cardiol. 43: 253–258.PubMedCrossRefGoogle Scholar
  34. 34.
    Waldhausen, J. A., and Nahrwold, D.L. 1966. Repair of coarctation of the aorta with subclavian flap. J. Thorac. Cardiovasc. Surg. 51: 532–533.PubMedGoogle Scholar
  35. 35.
    Liberthson, R.R.; Pennington, D.G.; Jacobs, M.L.; and Daggett, W.M. 1979. Coarctation of the aorta: review of 234 patients and clarification of management problems. Am. J. Cardiol. 43: 835–840.PubMedCrossRefGoogle Scholar
  36. 36.
    Sorland, S.J.; Rostad, H.; Forfang, K.; and Abyhohm, G. 1980. Coarctation of the aorta: a follow-up study after surgical treatment in infancy and childhood. Acta Paediatr. Scand. 69: 113–118.PubMedCrossRefGoogle Scholar
  37. 37.
    Beerman, L.B.; Neches, W.H.; Patnode, R.E.; Fricker, F.J.; Matthews, R.A.; and Park, S.C. 1980. Coarctation of the aorta: late results after surgery. Am. J. Dis. Child. 134: 464–466.PubMedGoogle Scholar
  38. 38.
    Hubbell, M.M., Jr.; O’Brien, R.G.; Krovetz, L.J.; Mauck, H.P.; and Tompkins, D.G. 1979. Status of patients 5 or more years after correction of coarctation of the aorta over age 1 year. Circulation 60: 74–80.PubMedGoogle Scholar
  39. 39.
    Maron, B.J.; Humphries, O.J.; Rowe, R.D.; and Mellits, E.D. 1973. Prognosis of surgically corrected coarctation of the aorta. Circ. Res. 47: 119–126.Google Scholar
  40. 40.
    Nanton, M.A., and Olley, D.M. 1976. Residual hypertension after coarctectomy in children. Am. J. Cardiol. 37: 769–772.PubMedCrossRefGoogle Scholar
  41. 41.
    Voors, A.W.; Webber, L.S.; Frerichs, R.R.; and Berenson, G.S. 1977. Body height and body mass as determinants of basal blood pressure in children. In: The Bogalusa heart study. Am. J. Epidemiol. 106: 101–108.Google Scholar
  42. 42.
    Feinleib, M.; Garrison, R.; Borhani, N.; Rosenman, R.; and Christian, J. 1975. Studies of hypertension in twins. In Epidemiology and control of hypertension, ed. O. Paul, pp. 3–20. New York: Stratton Intercontinental.Google Scholar
  43. 43.
    Biron, P.; Mongeau, J.G.; and Bertrand, D. 1975. Familial aggregation of blood pressure in adopted and natural children. In Epidemiology and control of hypertension, ed. O. Paul, pp. 397– 405. New York: Stratton Intercontinental.Google Scholar
  44. 44.
    Piatt, R. 1963. Heredity in hypertension. Lancet 1: 899–904.Google Scholar
  45. 45.
    Grim, C.E.; Luft, F.C.; Miller, J.Z.; Brown, P.L.; Gannon, M.A.; and Weinberger, M.H. 1979. Effects of sodium loading and depletion in normotensive first degree relatives of essential hypertensives. J. Lab. Clin. Med. 94: 764–771.PubMedGoogle Scholar
  46. 46.
    Grim, C.E.; Luft, F.C.; Miller, J.Z.; Rose, R.J.; Christian, J.C.; and Weinberger, M.H. 1980. An approach to the evaluation of genetic influences on factors that regulate arterial blood pressure in man. Hypertension 2: 134–142.Google Scholar
  47. 47.
    Falkner, B.; Onesti, G.; and Angelakos, E. 1981. Effect of salt loading on the cardiovascular response to stress in adolescents. Hypertension 3: 11195–11199.Google Scholar
  48. 48.
    Light, K.C.; Koepke, J.P.; Obrist, P.A.; Willis, P.W., IV. 1983. Psychological stress induces sodium and fluid retension in men at high risk for hypertension. Science 220: 429–431.PubMedCrossRefGoogle Scholar
  49. 49.
    Grignolo, A.; Koepke, J.P.; and Obrist, P.A. 1982. Renal function, heart rate, and blood pressure during exercise and avoidance in dogs. Am. J. Physiol. 242: R482 - R490.PubMedGoogle Scholar
  50. 50.
    Koepke, J.P.; Light, K.C.; and Obrist, P.A. 1983. Neural control of renal excretory function during behavioral stress in conscious dogs. Am. J. Physiol. 245: R251–R258.PubMedGoogle Scholar
  51. 51.
    Lundin, S., and Thoren, P. 1982. Renal function and sympathetic activity during mental stress in normotensive and spontaneously hypertensive rats. Acta Physiol. Scand. 115: 115–124.PubMedCrossRefGoogle Scholar
  52. 52.
    Anderson, D.E. 1982. Behavioral hypertension mediated by salt intake. In Circulation, neurobiology and behavior, ed. O. Smith, R-Galosy, and S. Weiss, pp. 247–257. New York: Elsevier.Google Scholar
  53. 53.
    Winternitz, S.R.; Katholi, R.E.; and Oparil, S. 1980. Role of the renal sympathetic nerves in the development and maintenance of hypertension in the spontaneously hypertensive rat. J. Clin. Invest. 66: 971–978.PubMedCrossRefGoogle Scholar
  54. 54.
    Winternitz, S.R.; Wyss, J.M.; Meadows, J.R.; and Oparil, S. 1982. Increased norepinephrine content of hypothalamic nuclei in association with worsening of hypertension following high sodium intake in the young spontaneously hypertensive rat. Clin. Sci. 63: 339s–343s.Google Scholar
  55. 55.
    Winternitz, S.R., and Oparil, S. 1982. Sodium-neural interactions in the development of spontaneous hypertension. Clin. Exp. Hypertension A4 (4/5): 751–760.CrossRefGoogle Scholar
  56. 56.
    De Champlain, J.; Krakoff, L.; and Axelrod, J. 1968. Relationship between sodium intake and norepinephrine storage during development of experimental hypertension. Circ. Res. 23: 479–491.Google Scholar
  57. 57.
    Berecek, K.H.; Winternitz, S.R.; Wyss, J.M.; and Oparil, S. 1983. Exaggerated cardiovascular responsiveness to central sympathetic and alpha adrenergic stimulation in spontaneously hypertensive rats receiving high sodium intake. Clin. Res. 31: 487A.Google Scholar
  58. 58.
    Lokhandwala, M.F., and Eikenburg, D.C. 1983. Presynaptic receptors and alterations in norepinephrine release in spontaneously hypertensive rats. Life Sci. 33: 1527–1542.PubMedCrossRefGoogle Scholar
  59. 59.
    Bianchi, G.; Cusi, D.; Gatti, M.; Plupi, G.; Ferrari, P.; Barlassina, C.; Picotti, G.P.; Bracchi, G.; Colombo, G.; Gori, D.; Velis, O.; and Mazzei, D. 1979. A renal abnormality as a possible cause of essential hypertension. Lancet 1: 173–177.PubMedCrossRefGoogle Scholar
  60. 60.
    Canessa, M.; Adragna, N.; Solomon, H.S.; Connolly, T.M.; and Tosteson, D.C. 1980. Increased sodium-lithium countertransport in red cells of patients with essential hypertension. N. Engl. J. Med. 302: 772–776.PubMedCrossRefGoogle Scholar
  61. 61.
    Garay, R.P.; Elghozi, J.L.; Dagher, G.; and Meyer, P. 1980. Laboratory distinction between essential and secondary hypertension by measurement of erythrocyte cation fluxes. N. Engl. J. Med. 302: 769–771.PubMedCrossRefGoogle Scholar
  62. 62.
    Woods, J.W.; Falk, R.J.; Pittman, A.W.; Klemmer, P.J.; Watson, B.S.; and Namboodiri, K. 1982. Increased red-cell sodium-lithium countertransport in normotensive sons of hypertensive parents. N. Engl. J. Med. 306: 593–595.PubMedCrossRefGoogle Scholar
  63. 63.
    Keen, P.M., and Bogdanski, D.F. 1970. Sodium and calcium ions in uptake and release of norepinephrine by nerve endings. Am. J. Physiol. 219: 677–682.PubMedGoogle Scholar
  64. 64.
    Bohr, D.F. 1964. Electrolytes and smooth muscle contraction. Pharmacol. Rev. 16: 85–111.PubMedGoogle Scholar
  65. 65.
    Blaustein, M.P. 1977. Sodium ions, calcium ions, blood pressure regulation, and hypertension: a reassessment and a hypothesis. Am. J. Physiol. 232 (3): C165–C173.PubMedGoogle Scholar
  66. 66.
    Haddy, F.J., and Overbeck, H.W. 1976. The role of humoral agents in volume expanded hypertension. Life Sci. 19: 935–948.PubMedCrossRefGoogle Scholar
  67. 67.
    De Wardner, H.E., and MacGregor, G.A. 1983. The role of a circulating inhibitor of Na +-K +-ATPase in essential hypertension. Am. J. Nephrol. 3: 88–91.CrossRefGoogle Scholar
  68. 68.
    Prebis, J.W.; Gruskin, A.B.; Polinsky, M.S.; and Baluarte, H.J. 1981. Uric acid in childhood essential hypertension. J. Pediatr. 98: 702–707.PubMedCrossRefGoogle Scholar
  69. 69.
    Schieken, R.M.; Clarke, W.R.; and Lauer, R.M. 1981. Left ventricular hypertrophy in children in the upper quintile of the blood pressure distribution: the Muscatine study. Hypertension 3: 669–675.PubMedGoogle Scholar
  70. 70.
    Zahka, K.G.; Neill, C.A.; Kidd, L.; Cutilletta, M.A.; and Cutilletta, A.F. 1981. Cardiac involvement in adolescent hypertension: echocardiographic determination of myocardial hypertrophy. Hypertension 3: 664–668.PubMedGoogle Scholar
  71. 71.
    Julius, S., and Schork, M.A. 1971. Borderline hypertension: a critical review. J. Chronic Dis. 23: 723–754.PubMedCrossRefGoogle Scholar
  72. 72.
    Stackpole, R.H.; Melicow, M.M.; and Uson, A.C. 1963. Pheochromocytoma in children. J. Pediatr. 63: 315–330.CrossRefGoogle Scholar
  73. 73.
    Sheps, S.; Van Heerden, J.; and Sheedy, P., II. 1981. Current approach to the diagnosis of pheo-chromocytoma. In Secondary forms of hypertension: current diagnosis and management, ed. M.D. Blaufox and C. Bianchi C, pp. 11–18. New York: Grune and Stratton.Google Scholar
  74. 74.
    Bravo, E.L.; Tarazi, R.C.; Gifford, R.W.; and Stewart, B.H. 1979. Circulating and urinary catecholamines in pheochromocytoma: diagnostic and pathophysiologic implications. N. Engl. J. Med. 301: 682–686.PubMedCrossRefGoogle Scholar
  75. 75.
    Bravo, E.L.; Tarazi, R.C.; Fouad, F.M.; Vidt, D.G.; and Gifford, R.W. 1981. Clonidine-suppression test: a useful aid in the diagnosis of pheochromocytoma. N. Engl. J. Med. 305: 623–626.PubMedCrossRefGoogle Scholar
  76. 76.
    Stewart, G.H.; Brown, E.L.; Haaga, J.; Meaney, T.F.; and Tarazi, R. 1978. Localization of pheochromocytoma by computed tomography. N. Engl. J. Med. 299: 460–461.PubMedCrossRefGoogle Scholar
  77. 77.
    Greenberg, R.E. 1975. Pheochromocytomas. In Endocrine and genetic diseases of childhood and adolescence, ed. L.I. Gardner, pp. 898–907. New York: W.B. Saunders.Google Scholar
  78. 78.
    Sisson, J.C.; Frager, M.S.; Valk, T.W.; Gross, M.D.; Swanson, D.P.; Wieland, D.M.; Tobes, M.C.; Beierwaltes, W.H.; and Thompson, N.W. 1981. Scintigraphic localization of pheochromocytoma. N. Eng. J. Med. 305: 12–17.CrossRefGoogle Scholar
  79. 79.
    Francis, I.R.; Glazer, G.M.; Shapiro, B.; Sisson, J.C.; and Gross, B.H. 1983. Complementary roles of CT and 131I–MIBG scintigraphy in diagnosing pheochromocytoma. AJR 141: 719–725.PubMedGoogle Scholar
  80. 80.
    Manger, W.M., and Gifford, R.W., Jr. 1977. Pheochromocytoma. Berlin: Springer–Verlag.Google Scholar
  81. 81.
    Wallace, J.M., and Gill, D.P. 1978. Prazosin in the diagnosis and treatment of pheochromocytoma. JAMA 240: 2752–2753.PubMedCrossRefGoogle Scholar
  82. 82.
    Rosei, E.A.; Brown, J.J.; Lever, A.F.; Robertson, A.S.; Robertson, J.I.S.; and Trust, P.M. 1976. Treatment of pheochromocytoma and of clonidine withdrawal hypertension with labetalol. Br. J. Clin. Pharmacol. Suppl 3, 3 (4): 809–815.Google Scholar
  83. 83.
    Sjoerdsma, A.; Engelman, K.; Spector, S.; and Udenfriend, S. Inhibition of catecholamine synthesis in man with alpha-methyl-tyrosine, an inhibitor of tyrosine hydroxylase. Lancet 2: 1092–1094.Google Scholar
  84. 84.
    New, M.I.; Oberfield, S.E.; and Levine, L.S. 1983. Hypertension in children. In Hypertension, ed. J. Genest, O. Kuchel, P. Hamet, and M. Cantin, pp. 853–889. New York: McGraw–Hill.Google Scholar
  85. 85.
    New, M.I.; Oberfield, S.E.; Levine, L.S.; Dupont, B.; Pollack, M.; Gill, J.R.; and Bartter, F.C. 1980. Demonstration of autosomal dominant transmission and absence of HLA linkage in dexamethasone suppressible hyperaldosteronism. Lancet 1: 550–551.PubMedCrossRefGoogle Scholar
  86. 86.
    Bravo, E.L.; Tarazi, R.C.; Dustan, H.P.; Fouad, F.M.; Textor, S.C.; Gifford, R.W.; and Vidt, D.G. 1983. The changing clinical spectrum of primary aldosteronism. Am. J. Med. 74: 641–651.PubMedCrossRefGoogle Scholar
  87. 87.
    Biglieri, E.G. 1976. A perspective on aldosterone abnormalities. Clin. Endocrinol. 5: 399–410.CrossRefGoogle Scholar
  88. 88.
    Ganguly, A.; Bergstein, J.; Grim, C.E.; Yum, M.N.; Weinberger, M.H. 1980. Childhood primary aldosteronism due to an adrenal adenoma: preoperative localization by adrenal vein catheterization. Pediatrics 65: 605–609.PubMedGoogle Scholar
  89. 89.
    White, E.A.; Schambelan, M.; Rost, C.R.; Biglieri, E.G. Moss, A.A.; Korobkin, M. 1980. Use of computed tomography in diagnosing the cause of primary aldosteronism. N. Engl. J. Med. 303: 1503–1507.PubMedCrossRefGoogle Scholar
  90. 90.
    Weinberger, M.H. 1983. Primary aldosteronism. In Hypertension, ed. J. Genest, O. Kuchel, P. Hamet, and M. Cantin, pp. 922–939. New York: McGraw-Hill.Google Scholar
  91. 91.
    Liddle, G.W. 1960. Tests of pituitary-adrenal suppressibility in the diagnosis of Cushing’s syndrome. J. Clin. Endocrinol. 12: 1539–1560.CrossRefGoogle Scholar
  92. 92.
    Balfe, J.W., and Ranee, C.P. 1978. Recognition and management of hypertensive crises in childhood. Pediatr. Clin. North. Am. 25: 159–174.PubMedGoogle Scholar
  93. 93.
    Multiple Risk Factor Intervention Trial Research Group. 1982. Multiple risk factor intervention trial: risk factor changes and mortality results. JAMA 248 (12): 1465–1477.CrossRefGoogle Scholar
  94. 94.
    Mirkin, B.L., and Sinaiko, A.R. 1978. Childhood hypertension: new therapeutic agents and management concepts. In Clinical pharmacology and therapeutics: a pediatric perspective, ed. B.L. Mirkin, pp. 251–272. Chicago: Yearbook Medical Publishers.Google Scholar
  95. 95.
    Oliver, M.F. 1982. Risks of correcting the risks of coronary disease and stroke with drugs. N. Engl. J. Med. 306: 297–298.PubMedCrossRefGoogle Scholar
  96. 96.
    Buhler, F.R.; Burkart, F.; Lutold, B.E.; et al. 1975. Antihypertensive beta blocking action as related to renin and age: A pharmacologic tool to identify pathogenic mechanisms in essential hypertension. Am. J. Cardiol. 36: 653–669.PubMedCrossRefGoogle Scholar
  97. 97.
    Berenson, G.S.; Voors, A.W.; Webber, L.S., et al. 1975. A model of intervention for prevention of early essential hypertension in the 1980’s. Hypertension 5: 41–54.Google Scholar

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© Martinus Nijhoff Publishing. Boston/The Hague/Dordrecht/Lancaster 1984

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  • Suzanne Oparil

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