Skip to main content

Advertisement

SpringerLink
Log in

A diagnostic approach for the child with hypertension

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Hypertension during childhood is not rare, with an estimated prevalence of between 1% and 2%, although it is often an underrecognized clinical entity. Elevated blood pressure may be a sign of underlying disease or it may represent early onset of essential hypertension. In recent years the measurement of blood pressure has been emphasized as an important component of the routine pediatric physical examination that enables early detection of children with hypertension. In the evaluation of the child with documented blood pressure elevation, confirmation of truly and persistently elevated blood pressure is of the utmost importance. In addition, a thorough history and a full clinical examination are essential. These are followed by appropriate investigations, which are tailored to the age of the child and to the severity of the blood pressure elevation. Investigations should not only focus on a search for the underlying cause, but also on establishing effects on target organs, complications or additional diseases and on assessment of the total cardiovascular risk to the individual patient. An algorithm, which is a valuable diagnostic tool for the diagnosis and management of the child with hypertension, is presented. All children with confirmed hypertension need long-term follow-up, counseling and treatment. In those cases where an underlying cause of the hypertension is detected, the established diagnosis then determines the specific therapy and management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Guidelines Committee (2003) European Society of Hypertension—European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 21:1011–1053

    Article  PubMed  Google Scholar 

  2. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics 144 [Suppl]:555–576

  3. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (1996) 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 98:649–658

    Google Scholar 

  4. Goonasekera CDA, Dillon MJ (2003) The child with hypertension. In: Webb N, Postlethwaite R (eds) Clinical paediatric nephrology, 3rd edn. Oxford University Press, Oxford, pp 151–161

  5. Swinford RD, Ingelfinger JR (1999) Evaluation of hypertension in childhood diseases. In: Barratt TM, Avner ED, Harmon WE (eds) Pediatric Nephrology, 4th edn. Lippincott Williams & Wilkins, Baltimore, pp 1007–1030

  6. Bartosh SM, Aronson AJ (1999) Childhood hypertension. An update on etiology, diagnosis and treatment. Pediatr Clin N Am 46:235–252

    Google Scholar 

  7. Hohn AR (1997) Diagnosis and management of hypertension in childhood. Pediatr Ann 26:105–111

    Google Scholar 

  8. Fernandes E, McCrindle BW (2000) Diagnosis and treatment of hypertension in children and adolescents. Can J Cardiol 16:801–811

    Google Scholar 

  9. Sinaiko AR, Gomez-Martin O, Prineas RJ (1989) Prevalence of “significant” hypertension in junior high school-aged children: the children and adolescent blood pressure program. J Pediatr 114:664–669

    Google Scholar 

  10. Adrogué HE, Sinaiko AR (2001) Prevalence of hypertension in junior high school-aged children: effect of new recommendations in the 1996 updated Task Force Report. Am J Hypertens 14:412–414

    Article  Google Scholar 

  11. Staessen JA, Wang J, Bianchi G, Birkenhäger WH (2003) Essential hypertension. Lancet 361:1629–1641

    Article  PubMed  Google Scholar 

  12. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ (2004) Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 113:475–482

    Google Scholar 

  13. Berenson GS (2002) Childhood risk factors predict adult risk associated with subclinical cardiovascular disease: the Bogalusa heart study. Am J Cardiol 90 [Suppl]:3L–7L

    Google Scholar 

  14. Lauer RM, Clarke WR, Mahoney LT, Witt J (1993) Childhood predictors for high adult blood pressure. The Muscatine study. Pediatr Clin N Am 40:23–40

    Google Scholar 

  15. O’Brien E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G, Megden T, Myers M, Padfield P, Palatini F, Parati G, Pickering T, Redon J, Staessen J, Stergiou G, Verdecciha P, on behalf of the European Society of Hypertension Working Group on Blood Pressure Monitoring (2003) European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 21:821–848

    Article  Google Scholar 

  16. Beevers G, Lip GYH, O’Brien E (2001) Blood pressure measurement. Part II—Conventional sphygmomanometry: technique of auscultatory blood pressure measurement. BMJ 322:1043–1047

    Article  Google Scholar 

  17. National Heart, Lung, and Blood Institute (1977) Report of the Task Force on Blood Pressure Control in Children. Pediatrics 59:797–820

    Google Scholar 

  18. Task Force on Blood Pressure Control in Children (1987) Report of the Second Task Force on Blood Pressure Control in Children—1987. Pediatrics 79:1—25

    PubMed  Google Scholar 

  19. de Man SA, André JL, Bachmann H, Grobbee DE, Ibsen KK, Laaser U, Lippert P, Hofman A (1991) Blood pressure in childhood: pooled findings of six European studies. J Hypertens 9:109–114

    PubMed  Google Scholar 

  20. Menghetti E, Virdis R, Strambi M, Patriarca V, Riccioni MA, Fossali E, Spagnolo A, on behalf of the Study Group on Hypertension of the Italian Society of Pediatrics (1999) Blood pressure in childhood and adolescence: the Italian normal standards. J Hypertens 17:1363–1372

    Article  Google Scholar 

  21. Goonasekera CDA, Dillon MJ (2000) Measurement and interpretation of blood pressure. Arch Dis Child 82:261–265

    Article  Google Scholar 

  22. Gomez-Marin O, Prineas RJ, Rastam L (1992) Cuff bladder width and blood pressure measurement in children and adolescents. J Hypertens 10:1235–1241

    Google Scholar 

  23. Elkasabany AM, Urbina EM, Daniels SR, Berenson GS (1998) Prediction of adult hypertension by K4 and K5 diastolic blood pressure in children: the Bogalusa heart study. J Pediatr 132:687–692

    Google Scholar 

  24. O’Brien E (2003) Demise of the mercury sphygmomanometer and the dawning of a new era in blood pressure measurement. Blood Press Monit 8:19–21

    Article  Google Scholar 

  25. Canznello VJ, Jensen PL, Schwartz GL (2001) Are aneroid sphygmomanometers accurate in hospital and clinic settings? Arch Intern Med 161:729–731

    Article  Google Scholar 

  26. O’Brien E, Waeber B, Parati G, Staessen J, Myers MG (2001) Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ 322:531–536

    Article  Google Scholar 

  27. O’Brien E, Beevers G, Lip GYH (2001) Blood pressure measurement. Part III—automated sphygmomanometry: ambulatory blood pressure measurement. BMJ 322:1110–1114

    Article  Google Scholar 

  28. Simckes AM, Srivastava T, Alon US (2002) Ambulatory blood pressure monitoring in children and adolescents. Clin Pediatr 41:549–564

    Google Scholar 

  29. Rucki Š, Feber J (2001) Repeated ambulatory blood pressure monitoring in adolescents with mild hypertension. Pediatr Nephrol 16:911–915

    Google Scholar 

  30. Lurbe E, Redon J (2002) Reproducibility and validity of ambulatory blood pressure monitoring in children. Am J Hypertens 15:69S–73S

    Article  Google Scholar 

  31. Flynn JT (2000) Impact of ambulatory blood pressure monitoring on the management of hypertension on children. Blood Press Monit 5:211–216

    Article  Google Scholar 

  32. Sorof JM (2000) White coat hypertension in children. Blood Press Monit 5:197–202

    Article  Google Scholar 

  33. Lingens N, Dobos E, Lemmer B, Schaerer K (1996) Nocturnal blood pressure elevation in transplanted pediatric patients. Kidney Int 55 [Suppl]:S175–S176

    Google Scholar 

  34. Flynn JT (2002) Differentiation between primary and secondary hypertension in children using ambulatory blood pressure monitoring. Pediatrics 110:89–93

    Google Scholar 

  35. Belsha CW (1999) Ambulatory blood pressure monitoring and hypertensive target-organ damage in children. Blood Press Monit 4:161–164

    Google Scholar 

  36. Soergl M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, Krull F, Reichert H, Reusz GS, Rascher W (1997) Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 130:178–184

    CAS  PubMed  Google Scholar 

  37. Wühl E, Witte K, Soergl M, Mehls O, Schaefer F, for the German Group on Pediatric Hypertension (2002) Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007

    Article  PubMed  Google Scholar 

  38. O’Sullivan JJ, Derrick G, Griggs P, Foxall R, Aitkin M, Wren C (1999) Ambulatory blood pressure in schoolchildren. Arch Dis Child 80:529–532

    Google Scholar 

  39. Gellermann J, Kraft S, Ehrich JHH (1997) Twenty-four-hour ambulatory blood pressure monitoring in young children. Pediatr Nephrol 11:707–710

    Google Scholar 

  40. Menghetti E, Cellitti R, Marsili D, Ferri M, Liberti A, Mucedola G (1997) 24 hour monitoring of blood pressure in premature and full-term newborn babies. Eur Rev Med Pharmacol Sci 1:189–191

    Google Scholar 

  41. Flynn JT (2001) What’s new in pediatric hypertension? Curr Hypertens Rep 3:503–510

    Google Scholar 

  42. Patzer L, Seeman T, Luck C, Wühl E, Janda J, Misselwitz J (2003) Day and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 142:117–122

    Google Scholar 

  43. Seeman T, John U, Blahova K, Vondřichova H, Janda J, Misselwitz J (2001) Ambulatory blood pressure monitoring in children with unilateral multicystic dysplastic kidney. Eur J Pediatr 160:78–83

    Google Scholar 

  44. Dillon MJ (1997) The diagnosis of renovascular disease. Pediatr Nephrol 11:366–372

    Google Scholar 

  45. Hiner LB, Falkner B (1993) Renovascular hypertension in children. Pediatr Clin N Am 40:123–140

    Google Scholar 

  46. Brun P, Kchouk H, Mouchet B, Baudouin V, Rainaud A, Loirat C, Azancot-Benisty A (1997) Value of Doppler ultrasound for the diagnosis renal artery stenosis in children. Pediatr Nephrol 11:27–30

    Article  CAS  PubMed  Google Scholar 

  47. Vasbinder GB, Nelemans PJ, Kessels AG, Kroon AA, de Leeuw PW, van Engelshoven JM (2001) Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med 135:401–411

    Google Scholar 

  48. Dillon MJ, Ryness JM (1975) Plasma renin activity and aldosterone concentration in children. Br Med J 4:316–319

    Google Scholar 

  49. Lenz T, Kia T, Rupprecht G, Schulte KL, Geiger H (1999) Captopril test: time over? J Hum Hypertens 13:431–435

    Article  Google Scholar 

  50. Goonasekera CDA, Shah V, Wade AM, Dillon MJ (2002) The usefulness of renal vein renin studies in hypertensive children: a 25-year experience. Pediatr Nephrol 17:943–949

    Google Scholar 

  51. Chandar JJ, Sfakianakis GN, Zilleruelo GE, Guerra JJ, Georgiou MF, Abitbol CL, Montane BS, Strauss J (1999) ACE inhibition scintigraphy in the management of hypertension in children. Pediatr Nephrol 13:493–500

    Google Scholar 

  52. Lagomarsino E, Orellana P, Munoz J, Velasquez C, Cavagnaro F, Valdes F (2004) Captopril scintigraphy in the study of arterial hypertension in pediatrics. 19:66–70

  53. Marcos HB, Choyke PL (2000) Magnetic resonance angiography of the kidney. Semin Nephrol 20:450–455

    Google Scholar 

  54. Vade A, Agrawal R, Lim-Dunham J, Hartoin D (2002) Utility of computed tomographic renal angiogram in the management of childhood hypertension. Pediatr Nephrol 17:741–747

    Google Scholar 

  55. Shahdadpuri J, Frank R, Gauthier BG, Siegel DN, Trachtman H (2000) Yield of renal arteriography in the evaluation of pediatric hypertension. Pediatr Nephrol 14:816–819

    Google Scholar 

  56. Rocchini AP (1993) Cardiovascular causes of systemic hypertension. Pediatr Clin N Am 40:141–147

    Google Scholar 

  57. Leandro J, Balfe JW, Smallhorn JF, Benson L (1992) Coarctation of the aorta and hypertension. Child Nephrol Urol 12:124–127

    Google Scholar 

  58. Savage MO, Lienhardt A, Lebrethon MC, Johnston LB, Huebner A, Grossman AB, Afshar F, Plowman PN, Besser GM (2001) Cushing’s disease in childhood: presentation, investigation, treatment and long-term outcome. Horm Res 55 [Suppl 1]:24–30

    Google Scholar 

  59. Rogoff D, Bergada I, Venara M, Chemes H, Heinrich JJ, Barontini M (2001) Intermittent hyperaldosteronism in a child due to an adrenal adenoma. Eur J Pediatr 160:114–116

    Google Scholar 

  60. Newman KD, Ponsky T (2002) The diagnosis and management of endocrine tumors causing hypertension in children. Ann N Y Acad Sci 970:155–158

    Google Scholar 

  61. Bravo EL, Tarazi RC, Gifford RW, Stewart BH (1979) Circulating and urinary catecholamines in pheochromocytoma. N Engl J Med 301:682–686

    Google Scholar 

  62. van der Harst E, de Herder WW, Bruining HA, Bonjer HJ, de Krijger RR, Lamberts SWJ, van den Meiracker AH, Boomsma F, Stijnen T, Krenning EP, Bosman FT, Kwekkeboom DJ (2001) [123I]Metaiodobenzylguanidine and [111In] octreotide uptake in benign and malignant pheochromocytomas. J Clin Endocrinol Metab 86:685–693

    Google Scholar 

  63. Luft PC (1998) Molecular genetics of human hypertension. J Hypertens 16:1871–1878

    Article  Google Scholar 

  64. Melander O (2001) Genetic factors of hypertension—what is known and what does it mean? Blood Press 10:254–270

    Article  Google Scholar 

  65. Rocchini AP (2002) Obesity hypertension. Am J Hypertens 15:50S–52S

    Article  Google Scholar 

  66. Gao PJ, Zhang KX, Zhu DL, He X, Han ZY, Zhan YM, Yang LW (2001) Diagnosis of Liddle syndrome by genetic analysis of ß and γ subunits of epithelial sodium channel—a report of five affected family members. J Hypertens 19:885–889

    Article  Google Scholar 

  67. Cerame BI, New MI (2000) Hormonal hypertension in children: 11ß-hydroxylase deficiency and apparent mineralocorticoid excess. J Pediatr Endocrinol Metab 13:1537–1547

    Google Scholar 

  68. Lifton RP, Dluhy RG, Powers M, Rich GM, Cook S, Ulick S, Lalovel JM (1992) A chimaeric 11ß-hydroxylase/aldosterone synthase gene causes glucocorticoid-remediable aldosteronism and human hypertension. Nature 355:262–265

    Google Scholar 

  69. Yap HK, Low PS, Lee BW, Murugasu B, Yip WC, Tay JS (1988) Factors influencing the development of hypertensive encephalopathy in acute glomerulonephritis. Child Nephrol Urol 9:147–152

    Google Scholar 

  70. Proulx F, Lacroix J, Farrell CA, Gauthier M (1993) Convulsions and hypertension in children: differentiating cause from effect. Crit Care Med 21:1541–1546

    Google Scholar 

  71. Adelman RD, Coppo R, Dillon MJ (2000) The emergency management of severe hypertension. Pediatr Nephrol 14:422–427

    Google Scholar 

  72. Deal JE, Barratt TM, Dillon MJ (1992) Management of hypertensive emergencies. Arch Dis Child 67:1089–1092

    CAS  PubMed  Google Scholar 

  73. Daniels SR, Meyer RA, Strife CF, Lipman ML, Loggie JMH (1990) Distribution of target-organ abnormalities by race and sex in children with essential hypertension. J Hum Hypertens 4:103–104

    Google Scholar 

  74. Daniels SR, Witt SA, Glaskock B, Khoury PR, Kimball TR (2002) Left atrial size in children with hypertension: the influence of obesity, blood pressure, and left ventricular mass. J Pediatr 141:186–190

    Google Scholar 

  75. Kay JD, Sinaiko AR, Daniels SR (2001) Pediatric hypertension. Am Heart J 142:422–432

    Article  Google Scholar 

  76. Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA (1998) Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa heart study. N Engl J Med 338:1650–1656

    Article  Google Scholar 

  77. Munoz S (2000) Blood pressure studies in paediatric populations: metabolic syndrome in hypertensive children and adolescents. J Hum Hypertens 14 [Suppl 1]:S10–S15

    Google Scholar 

  78. Maffeis C, Pietrobelli A, Grezzani A, Provera S, Tato L (2001) Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res 9:179–187

    CAS  PubMed  Google Scholar 

  79. Sinaiko AR, Steinberger J, Moran A, Prineas RJ, Jacobs DR Jr (2002) Relation of insulin resistance to blood pressure in childhood. J Hypertens 20:509–517

    Article  Google Scholar 

  80. Glowinska B, Urban M, Koput A, Galar M (2003) New atherosclerosis risk factors in obese, hypertensive and diabetic children and adolescents. Atherosclerosis 167:275–286

    Article  Google Scholar 

  81. McGill HC, McMahan CA, Herderick EE, Malcom GT, Tracy RE, Strong JP (2000) Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr 72 [Suppl]:S1307–S1315

    Google Scholar 

  82. Gillman MW, Ellison RC (1993) Childhood prevention of essential hypertension. Pediatr Clin N Am 40:179–194

    Google Scholar 

  83. Kaplan NM (1994) Management of hypertensive emergencies. Lancet 344:1335–1338

    Article  Google Scholar 

  84. Bigazzi R, Bianchi S, Baldari D, Campese VM (1998) Microalbuminuria predicts cardiovascular events and renal insufficiency in patients with essential hypertension. J Hypertens 16:1325–1333

    Article  Google Scholar 

  85. Rodicio JL, Campo C, Ruilope LM (1998) Microalbuminuria in essential hypertension. Kidney Int 68 [Suppl]:S51–S54

  86. Yiu VWY, Dluhy RP, Lifton RP, Guay-Woodford LM (1997) Low peripheral plasma renin activity as a critical marker in pediatric hypertension. Pediatr Nephrol 11:343–346

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Maribor Teaching Hospital, Ljubljanska 5, 2000, Maribor, Slovenia

    Nataša Marčun Varda & Alojz Gregorič

Authors
  1. Nataša Marčun Varda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alojz Gregorič
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nataša Marčun Varda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Varda, N.M., Gregorič, A. A diagnostic approach for the child with hypertension. Pediatr Nephrol 20, 499–506 (2005). https://doi.org/10.1007/s00467-004-1737-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-004-1737-0

Keywords

Search

Navigation