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- Tammy M. Brady, MD, MHS
- Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD.
Author Disclosure
Dr Brady has disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.
Educational Gap
Pediatric hypertension is on the rise, now affecting almost 5% of all children. Clinicians should be following the latest guidelines on management of pediatric hypertension, including recommendations to measure blood pressure at every visit in all children age 3 years and older and some at-risk children younger than age 3 years, as well as to employ pharmacologic therapy for some children.
Objectives
After completing this article, readers should be able to:
Define hypertension in children, and be familiar with the approach to the diagnosis of hypertension.
Recognize important signs and symptoms associated with hypertension and its sequelae, and formulate an appropriate differential when presented with a hypertensive child or adolescent.
Initiate an appropriate evaluation, and know when to refer to subspecialty care.
Prescribe both nonpharmacologic and pharmacologic antihypertensive therapy to hypertensive children, and be familiar with the various classes of antihypertensive medications available.
Case Study
Jennifer is a 12-year-old girl who plays field hockey and is in your office for a sports physical. She reports feeling well, denies any complaints, and has no significant past medical history. She is not taking any medications. Family history is reviewed and is significant only for grandparents on both sides of the family having hypertension (HTN) and a paternal grandfather who had a myocardial infarction at age 60 years and is still living. She is a straight A student and lives at home with her parents and 2 brothers, who are healthy. Review of systems is significant for achieving menarche several months earlier.
Physical examination shows both her height and weight to be at the 50th percentile. Blood pressure (BP) was 136/82 mm Hg initially in triage; repeat is 132/78 mm Hg …
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