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The changing face of pediatric hypertension in the era of the childhood obesity epidemic

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Abstract

Historically, hypertension in childhood was thought to be an uncommon diagnosis, usually related to an underlying condition, most often parenchymal renal disease. Primary hypertension in childhood was felt to be quite rare. However, the worldwide childhood obesity epidemic has had a profound impact on the frequency of hypertension and other obesity-related conditions with the result that primary hypertension should now be viewed as one of the most common health conditions in the young. This review will present updated data on the prevalence of hypertension in children and adolescents, the impact of the childhood obesity epidemic on hypertension prevalence and blood pressure levels, shifts in how often primary hypertension is being diagnosed in childhood, and an overview of the pathophysiology of obesity-related hypertension. It is hoped that improved understanding of the significance of these issues will lead to improved recognition and treatment, which will be the key to averting an epidemic of cardiovascular disease in adulthood.

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Author information

Authors and Affiliations

  1. Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA

    Joseph Flynn

  2. Division of Nephrology, A-7931, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Joseph Flynn

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  1. Joseph Flynn
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Correspondence to Joseph Flynn.

Additional information

Answers:

1. a

2. b

3. c

4. d

5. a

Multiple choice questions (answers are provided following the reference list)

Multiple choice questions (answers are provided following the reference list)

  1. 1.

    You are asked to evaluate a 5½-year-old girl for elevated BP. Her prior BP readings are consistent with stage 1 hypertension. Her height, weight, and BMI are all at the 99th percentile for age. Her physical examination is remarkable only for abdominal striae. Which of the following diagnostic studies would be least appropriate at this time?

    1. a)

      Urine microalbumin to creatinine ratio

    2. b)

      Electrolytes, BUN, and creatinine

    3. c)

      Complete renal ultrasound

    4. d)

      Fasting glucose and lipid panel

  2. 2.

    Current data indicate that in less developed countries, obesity-related hypertension need not be considered in the differential diagnosis of a hypertensive adolescent.

    1. a)

      True

    2. b)

      False

  3. 3.

    An obese adolescent with elevated blood pressure has undergone 24-h ambulatory BP monitoring. Salient findings include: elevated mean awake SBP, normal mean awake DBP, normal mean sleep SBP and DBP, SBP dipping 19 %, DBP dipping 12.5 %, mean awake heart rate 101, mean sleep heart rate 85. Which of the following mechanisms is most likely to account for this patient’s hypertension?

    1. a)

      Volume expansion

    2. b)

      Elevated plasma renin activity

    3. c)

      Increased CNS sympathetic output

    4. d)

      Parenchymal renal disease

  4. 4.

    Population data from the United States have demonstrated several changes affecting childhood blood pressure over the past 1–2 decades. Which of the following statements best summarizes those changes?

    1. a)

      Absolute BP levels have increased among white children and the prevalence of hypertension among Mexican–American children has remained stable.

    2. b)

      Absolute BP levels have increased among all groups of children, with the greatest changes seen among white children

    3. c)

      Absolute BP levels have remained stable among all groups of children, but the prevalence of pre-hypertension has increased markedly

    4. d)

      Absolute BP levels and the prevalence of hypertension have varied among children of different racial and ethnic groups

  5. 5.

    Adipocytes are just as likely to contribute to hypertension in obese children as are juxtaglomerular cells.

    1. a)

      True

    2. b)

      False

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Flynn, J. The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol 28, 1059–1066 (2013). https://doi.org/10.1007/s00467-012-2344-0

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  • DOI: https://doi.org/10.1007/s00467-012-2344-0

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