Abstract
Early hypertension has generally been considered to be an asymptomatic condition; however, recent data show that many hypertensive children have evidence of end organ damage. We sought to determine if a spectrum of common symptoms is associated with early hypertension and whether those symptoms resolve with lowered blood pressure. Four hundred and nine consecutive children, 7–18 years old, examined in the Texas Children’s Hospital Hypertension Clinic for new-onset high blood pressure (BP) completed a questionnaire, including the self-reporting of 15 symptoms potentially attributed to high blood pressure. Subjects received anti-hypertensive treatment and repeated the questionnaire 4–6 months after initiation of therapy. One-hundred fifty healthy, normotensive children completed the questionnaire as controls. Of hypertensive children, 64% were symptomatic, compared with 26% of normotensive children (P<0.001). Fifty-one percent of hypertensive children reported 1–4 symptoms, 14% >4 symptoms. Following treatment only 28% of children remained symptomatic. The three most common symptoms in hypertensive patients, headache, 42%, difficulty initiating sleep, 27%, and daytime tiredness, 26%, were markedly reduced with treatment, to 6.2%, 1.5% and 10%, respectively (P<0.001). We conclude that newly diagnosed hypertensive children had a variety of non-specific symptoms, more prevalent than those of normotensive children, and most somatic complaints improved with 4–6 months of anti-hypertensive treatment.
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Bulpitt CJ, Fletcher AE, Thijs L, Staessen JA, Antikainen R, Davidson C, Fagard R, Gil-Extremera B, Jaaskivi M, O’Brien E, Palatini P, Tuomilehto J (1999) Symptoms reported by elderly patients with isolated systolic hypertension: baseline data from the SYST-EUR trial. Systolic Hypertension in Europe. Age Ageing 28:15–22
Anderson RT, Hogan P, Appel L, Rosen R, Shumaker SA (1997) Baseline correlates with quality of life among men and women with medication-controlled hypertension. The trial of nonpharmacologic interventions in the elderly (TONE). J Am Geriatr Soc 45:1080–1085
Stoohs RA, Gingold J, Cohrs S, Harter R, Finlayson E, Guilleminault C (1996) Sleep-disordered breathing and systemic hypertension in the older male. J Am Geriatr Soc 44:1295–1300
Suka M, Yoshida K, Sugimori H (2003) Persistent insomnia is a predictor of hypertension in Japanese male workers. J Occup Health 45:344–350
Zizi F, Jean-Louis G, Magai C, Greenidge KC, Wolintz AH, Heath-Phillip O (2002) Sleep complaints and visual impairment among older Americans: a community-based study. J Gerontol A Biol Sci Med Sci 57:M691–694
Gidding SS, Bao W, Srinivasan SR, Berenson GS (1995) Effects of secular trends in obesity on coronary risk factors in children: the Bogalusa Heart Study. J Pediatr 127:868–874
Muntner P, He J, Cutler JA, Wildman RP, Whelton PK (2004) Trends in blood pressure among children and adolescents. JAMA 291:2107–2113
Stabouli S, Kotsis V, Toumanidis S, Papamichael C, Constantopoulos A, Zakopoulos N (2005) White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol 20:1151–1155
Stary HC (1989) Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults. Arteriosclerosis 9:I19–I32
Mahoney LT, Burns TL, Stanford W, Thompson BH, Witt JD, Rost CA, Lauer RM (1996) Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study. J Am Coll Cardiol 27:277–284
Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, Jarvisalo MJ, Uhari M, Jokinen E, Ronnemaa T, Akerblom HK, Viikari JS (2003) Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 290:2277–2283
Litwin M, Trelewicz J, Wawer Z, Antoniewicz J, Wierzbicka A, Rajszys P, Grenda R (2004) Intima-media thickness and arterial elasticity in hypertensive children: controlled study. Pediatr Nephrol 19:767–774
Burke GL, Arcilla RA, Culpepper WS, Webber LS, Chiang YK, Berenson GS (1987) Blood pressure and echocardiographic measures in children: the Bogalusa Heart Study. Circulation 75:106–114
Pontremoli R, Nicolella C, Viazzi F, Ravera M, Sofia A, Berruti V, Bezante GP, Del Sette M, Martinoli C, Sacchi G, Deferrari G (1998) Microalbuminuria is an early marker of target organ damage in essential hypertension. Am J Hypertens 11:430–438
Lande MB, Kaczorowski JM, Auinger P, Schwartz GJ, Weitzman M (2003) Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States. J Pediatr 143:720–724
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 114:555–576
Soergel 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
Feig DI, Johnson RJ (2003) Hyperuricemia in childhood primary hypertension. Hypertension 42:247–252
Varda NM, Gregoric A (2005) A diagnostic approach for the child with hypertension. Pediatr Nephrol 20:499–506
Flynn JT, Alderman MH (2005) Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol 20:961–966
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Dr. Feig was supported by NIH grants DK064587, DK071223 and RR17665.
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Croix, B., Feig, D.I. Childhood hypertension is not a silent disease. Pediatr Nephrol 21, 527–532 (2006). https://doi.org/10.1007/s00467-006-0013-x
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DOI: https://doi.org/10.1007/s00467-006-0013-x