Management of pediatric hypertension

Hypertension is one of the major contributors to cardiovascular, renal and CNS morbidity and mortality. Although it is more prevalent in adults, hypertension and its sequelae are being seen with increasing frequency in pediatrics recently. The majority of children have hypertension secondary to renovascular and renal parenchymal disease, and it appears that the increased incidence is primarily related to the epidemic of obesity, which is a known risk factor for the development of the condition. After the diagnosis of hypertension is established, a thorough evaluation for secondary causes should be conducted according to existing guidelines. Nonpharmacologic interventions should be discussed in any child, even though the diagnosis of hypertension may not be confirmed, but if risk factors are identified. Those interventions should be even more encouraged if the diagnosis of hypertension or prehypertension is confirmed. Nonpharmacologic intervention focuses on salt restriction, diet modification, exercise and physical activity, as well as improved sleep habits. Initiation of medical therapy is guided by the degree of blood pressure elevation, presence of symptoms and existing risk factors. A wide variety of oral medications and intravenous therapies are available for use in children with mild, moderate or severe blood pressure elevations. This article reviews the diagnosis and evaluation of hypertension in children, and provides an update on the pharmacologic and nonpharmacologic treatment options for hypertension, including hypertensive urgency and emergency.