Hypertensive Disease in Childhood
School year has started and we get to see children for physical examination as a requirement for medical certificates allowing them to join sports activities.
This is one opportunity for us paediatricians to assess children’s general health.
And, most often we see that some are underweight for age, overweight for age and that their blood pressures are high.
Essential hypertension is rare in children.
The following are the more common causes:
1. Renal disease
2. Diseases of the central nervous system
3. Coarctation of the aorta
4. Endocardial disturbances.
Hypertension is suggested if the blood pressure values are two standard deviation above the mean for age.
The renal causes of hypertension in children are the following:
1. Acute and chronic glomerulonephritis
2. Pyelonephritis
3. Polycystic renal disease
4. Tumors
5. Ectopic kidney
6. Hypoplastic kidney
7. Hydronephrosis
8. Renovascular anomalies
9. Polyarteritis
10. Radiation nephropathy
Conditions in the central nervous system that may elevate blood pressure are the following:
1. Poliomylitis
2. Encephalitis
3. Rapidly expanding intracranial lesions
4. Polyneuritis
5. Dysautonomia
The cardiovascular causes of elevated blood pressures are:
1. Coarctation of the aorta
2. Aortic runoffs like anemia, AV fistula, thyrotoxicosis
The endocrine- metabolic causes are the following:
1. ACTH therapy
2. Pheochromocytoma
3. Cushing’s syndrome
4. Hypertensive adrenogenital syndrome
5. Primary aldosteronism
6. Porphyria
Poisonings due to lead and mercury could also be a cause of increase in blood pressure among children.
In the treatment of hypertension, the cause or etiology should be corrected if possible.
In children, the prognosis is dependent on the underlying disease. And that experts said that the curability of hypertension in children is far greater than in adults.
So, parents please have your children be seen by their favorite pediatricians for thorough physical examination.