NHBMANAGEMENT OF HYPERTENSION IN CHILDREN AND ADOLESCENTS: FROM DIAGNOSIS TO TREATMENT

Key words: Hypertension, Antihypertensive drugs, Obesity, Hypertensive emergencies, Left ventricular hypertrophy

The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make identification and treatment of hypertension an important focus of physicians caring for children. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is an emerging condition in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a thorough history and physical examination, laboratory tests, and specialized studies. Lifestyle modifications are advised for all patients and can be tried solely for those with blood pressures between the 95th and 99th percentiles. Drug therapy is indicated in children with blood pressures greater than the 99th percentile, secondary hypertension, coexisting diabetes, left ventricular hypertrophy, or those who fail a trial of non pharmacologic treatment.