Pedi HTN
Causes of HTN in children and adolescents
o Primary
Adolescents – obesity (primary HTN)
o Secondary causes
Early childhood (6-8 yr old) – HTN associated with renal disease
Renal disease
o Pyelonephritis, glomerulonephritis,
o Hemolytic uremic syndrome
o Renal trauma, stones, wilms tumor
o Polycystic kidney disease
Endocrine
o Hyperthyroid, cushing, aldosteronism, hyperparathyroid
o Adrenal hyperplasia
o Diabetes
o Hypercalcemia
o Pheochromocytoma
Neuro
o Incr ICP
o Guillian barre
Psych
o Stress, anxiety
Pharmacologic
o Sympathomimetics, stimulants, steroids
o Corticosteroids
o Drugs – cocaine, nicotine, phencyclidine (PCP)
o Caffeine
o Licorice
Vascular disease
o Renal – artery abn, vein thrombosis
o Coarct of aorta, PCA
o AV fistula
Other
o Neuroblastoma
o Heavy metal poisoning
o Acute pain
o Collagen vascular diseases
o Neurofibromatosis, tuberous sclerosis
, Guidelines for dx and tx
o 2017 criteria for dx
Children (ages 1-12) Adolescents
Normal BP < 90 %tile < 120/80
(90% or 120/80) – 95 %tile
Elevated BP 120-129/<80
(lower range = which ever is lower)
95%tile – (95%tile + 12mmHg)
Stage 1 or 130-139/80-89
130-139/80-89
> (95% + 12mm Hg)
Stage 2 or >= 140/90
> 140/90
, o Screening
Children > 3 yr old annual BP (not every visit)
Special considerations for children < 3 yrs
Hx:
o Prematurity, very low birth weight, intensive care as neonate
o Congenital heart disease
o Renal issues
Recurrent UTI, hematuria, proteinuria
Known renal disease, urologic malformations, fam hx of congenital renal
disease
o Transplants – solid organ, bone marrow transplant, malignancy
o Evidence if increased ICP
o Taking drugs/illnesses that raise BP
Neurofibromatosis
Tuberous sclerosis
Causes of HTN in children and adolescents
o Primary
Adolescents – obesity (primary HTN)
o Secondary causes
Early childhood (6-8 yr old) – HTN associated with renal disease
Renal disease
o Pyelonephritis, glomerulonephritis,
o Hemolytic uremic syndrome
o Renal trauma, stones, wilms tumor
o Polycystic kidney disease
Endocrine
o Hyperthyroid, cushing, aldosteronism, hyperparathyroid
o Adrenal hyperplasia
o Diabetes
o Hypercalcemia
o Pheochromocytoma
Neuro
o Incr ICP
o Guillian barre
Psych
o Stress, anxiety
Pharmacologic
o Sympathomimetics, stimulants, steroids
o Corticosteroids
o Drugs – cocaine, nicotine, phencyclidine (PCP)
o Caffeine
o Licorice
Vascular disease
o Renal – artery abn, vein thrombosis
o Coarct of aorta, PCA
o AV fistula
Other
o Neuroblastoma
o Heavy metal poisoning
o Acute pain
o Collagen vascular diseases
o Neurofibromatosis, tuberous sclerosis
, Guidelines for dx and tx
o 2017 criteria for dx
Children (ages 1-12) Adolescents
Normal BP < 90 %tile < 120/80
(90% or 120/80) – 95 %tile
Elevated BP 120-129/<80
(lower range = which ever is lower)
95%tile – (95%tile + 12mmHg)
Stage 1 or 130-139/80-89
130-139/80-89
> (95% + 12mm Hg)
Stage 2 or >= 140/90
> 140/90
, o Screening
Children > 3 yr old annual BP (not every visit)
Special considerations for children < 3 yrs
Hx:
o Prematurity, very low birth weight, intensive care as neonate
o Congenital heart disease
o Renal issues
Recurrent UTI, hematuria, proteinuria
Known renal disease, urologic malformations, fam hx of congenital renal
disease
o Transplants – solid organ, bone marrow transplant, malignancy
o Evidence if increased ICP
o Taking drugs/illnesses that raise BP
Neurofibromatosis
Tuberous sclerosis
