Children's health

High Blood Pressure in Children


Hypertension in children

Hypertension – a persistent increase in blood pressure above 95th centile scale distribution of blood pressure values for a specific age, sex, weight and length of baby’s body. Normal blood pressure is considered systolic and diastolic blood pressure, not beyond the 10th and 90th centiles. High normal blood pressure or borderline hypertension is considered the value of blood pressure between the 90th and 95 th centiles. Children with this blood pressure are at risk and need medical supervision.

Hypertension in adults – one of the most common cardiovascular diseases. Hypertension affects up to 1/3 of Ukraine’s population, while 40% of them don’t know it and therefore do not receive treatment. Therefore, these serious complications of hypertension such as myocardial infarction or stroke, arise quite suddenly.

Prevalence of arterial hypertension in children, according to different authors, ranges from 1% to 14%, among pupils of 12-18%. In children the first year of life, and early and preschool age arterial hypertension is extremely rare and in most cases has a secondary symptomatic. Most are predisposed to the development of arterial hypertension children prepubertal and pubertal age, which is largely determined by the characteristic period of childhood autonomic dysfunction.

Causes of High Blood Pressure in Children

In most cases of persistent hypertension in children is secondary. The structure of causes of arterial hypertension have a distinct age-related features; while the predominant renal pathology.

Most common causes of hypertension in children according to age

Age group
Causes of hypertension
Newborn
0-6 years
6-10 years
Teenagers
Stenosis or thrombosis of the renal arteries, congenital structural renal anomalies, coarctation of aorta, bronchopulmonary dysplasia
Structural and inflammatory diseases of the kidney, coarctation of aorta, renal artery stenosis, Wilms tumor
Structural and inflammatory diseases of the kidneys, renal artery stenosis, essential (primary) arterial hypertension, parenchymal renal disease
Parenchymal renal disease, essential arterial hypertension

More rare (not age related) causes of secondary hypertension, systemic vasculitis, diffuse connective tissue disease, and endocrine disease (pheochromocytoma, neuroblastoma, hyperparathyroidism, congenital adrenal hyperplasia, primary hyperaldosteronism, endogenous or exogenous Cushing’s syndrome). Increasing systemic blood pressure may be accompanied by hypertension-hydrocephalic syndrome and the abuse of agonists [ephedrine, salbutamol, naphazoline (e.g., naphazoline), etc.].

Primary Diagnosis, i.e. essential, hypertension put after excluding all diseases that can cause high blood pressure (secondary symptomatic hypertension). The etiology of essential arterial hypertension is associated with many factors, especially heredity.

The risk factors of hypertension include:

  • constant emotional stress, conflict situations in family and school;
  • the personal characteristics of the child (anxiety, suspiciousness, propensity to depressions, fears, etc.) and the response to stress;
  • overweight;
  • peculiarities of metabolism (hyperuricemia, low glucose tolerance, the violation of the ratio of fractions of cholesterol);
  • excessive consumption of salt.

Other groups at risk include children with a history of hypertension heredity, adolescents with high normal blood pressure (90-95 th centile).

Treatment of pediatric hypertension

Hypertension often develops on the background of genetic anomalies (some of which is well established, for example angiotensin gene mutation, mutation, leading to the expression of the enzyme aldosteroneinduced). The influence of precipitating factors contributes to the violation of the mechanisms of autoregulation, normally maintain the balance between cardiac output and peripheral vascular resistance.

Treatment of pediatric hypertensionConsider that the role of the starting mechanism of development of arterial hypertension in children playing multiple negative psycho-emotional impacts that amid such personal characteristics typical of adolescents, such as anxiety, suspiciousness, etc., cause permanent overvoltage of sympathoadrenal system, accompanied by spasm of smooth muscles of arterioles. Further, the process involved circulating (angiotensin II, antidiuretic hormone (ADH)) and local (endothelium) vasoconstrictor factors, which resist the action of antihypertensive system (natriuretic peptides, the PGE2 and PGE12, of the kallikrein-kinin system, nitric oxide, etc.). Blood pressure begins to rise when excessive increased activity of vasoconstrictors or depletion of vasodepressor systems.

Continuing strain of sympathoadrenal system is accompanied by activation of sympathetic innervation of the kidneys and spasm of the renal vessels, which contributes to the inclusion in the pathogenesis of the renin-angiotensin-aldosterone system – leading pathogenetic mechanism of development of secondary renal hypertension.

First temporary, and then permanent spasm of the arterioles leads to hypertrophy of smooth muscle cells, which is supported by the increase of intracellular concentration of free ionized calcium.

In the pathogenesis of hypertension are important, and other metabolic disorders, which is indicative of early formation in children the so-called metabolic syndrome, adult. Thus, in adolescents with persistent hypertension and overweight often find a hyperuricemia, increased concentration of cholesterol low-density lipoprotein and decreasing concentrations of high density lipoprotein, hypertriglyceridemia, impaired glucose tolerance.

Types of hypertension in children

Generally Accepted classification of hypertension in children is not. The adult classification is based on the level of arterial pressure and degree of defeat of target organs; thus there are three stages of the disease. In children, hypertension is classified by systolic blood pressure in different age groups (the Second working group on control of blood pressure in children; USA, 1987).

for hypertension at any age can be divided into benign and malignant forms.

Criteria of hypertension in children according to age

Age
Systolic blood
pressure (mm Hg)
Reasonable
hypertension
Expressed
hypertension
7 days
>96
>106
8-30 days
>104
> 110
To 2 years
> 112
> 118
3-5 years
>116
>124
6-9 years
>122
> 130
10-12 years
>126
>134
13-15 years
>136
>144
16-18 years
>142
>150

Complications of high blood pressure in child

In moderate arterial hypertension clinical manifestations may be absent, the child and his parents may be unaware of its presence. Possible complaints of headache, fatigue, irritability. An objective examination often reveal the excess weight and length of the body, manifestations of autonomic dysfunction, undifferentiated mesenchymal dysplasia (asthenic physique, microanomalies structure of the heart and kidneys, etc.).

In severe hypertension (stage II adult) children feel violated always. In addition to more pronounced and constant headaches children celebrate dizziness, loss of memory, palpitations, pain in the heart area. On physical examination finds tachycardia, expansion of borders of heart to the left, increased heart tones with accent II tone of the aorta, the ECG and Echocardiography to detect signs of left ventricular hypertrophy, in the study of the fundus – the narrowing of blood vessels of the retina.

Malignant hypertension (most often in secondary renal hypertension) is characterized by persistent elevated blood pressure to high values and low efficiency of treatment. This type of hypertension is characterized by a high mortality rate.

Hypertensive crisis is characterized by development of complications:

  • acute hypertensive encephalopathy with sudden headache, nausea, vomiting, visual disturbances, impaired consciousness, convulsions;
  • acute left ventricular failure with pulmonary edema, shortness of breath, pain in region of heart;
  • acute renal failure with oliguria, hematuria, proteinuria.