Hypertension in Children and Adolescents

Education Gap

Hypertension in children and adolescents is often underdiagnosed. Blood pressure should be assessed at every medical encounter in children aged 3 years and older, as well as high-risk children younger than 3 years. Pharmacologic therapy is safe and effective for controlling blood pressure and preventing end-organ changes in this population.

Objectives

After completing this article, readers should be able to:

1. Recognize and properly classify hypertension in children and adolescents.

2. Develop a differential diagnosis and diagnostic approach for evaluation of hypertension, based on signs and symptoms.

3. Initiate a discussion with patients and their families on the nonpharmacologic management of hypertension.

4. Discuss the classes of antihypertensive medications used in children and adolescents.

Case Study

Danielle is a 16-year-old who presents to your office for a routine health maintenance visit. She has generally been feeling well, except for occasional headaches. They do not localize to a specific location, and they occur weekly and resolve spontaneously. They are not associated with any other neurological symptoms. Her past medical history is unremarkable. She is not taking any medications. Her family history is remarkable for hypertension in both the maternal and paternal grandparents. The review of systems has yielded otherwise negative findings.

The physical examination showed a height at the 25th percentile and a weight in the 75th percentile. Initial blood pressure obtained by using an automated oscillometric device was 154/82 mm Hg. At examination, she was well appearing and in no distress. Her physical examination findings were normal, except for a dark, velvety discoloration on her neck. A manual auscultatory blood pressure obtained at the end of the physical examination with the appropriately sized cuff and with the patient sitting was 134/78 mm Hg.