You reference the BP tables published in the Fourth
Report by the National High Blood Pressure Education
Program Working Group on High Blood Pressure in Children
and Adolescents,1
and discover that the BP norms for
a child of this age, gender, and height percentile are as
follows:
50%: 102/61
90%: 116/76
95%: 120/80
99%: 127/88
This clinical scenario of a child found to have an
elevated initial blood pressure is not uncommon. Pediatric
hypertension, previously reported to affect only 0.3% to
1.2% of children in the 1970s and 1980s,2,3 now affects
up to 5% of all children.4 One possible explanation for
this increase may be the current growing population
of obese children.5
The prevalence of hypertension in
children increases with increasing BMI percentile,4
placing
obese children at three-times higher risk of becoming
hypertensive when compared to non-obese children.5
Regardless of the cause for this increase, a child with
hypertension can be a dilemma for many primary care
providers. It is essential for providers to understand when
to screen for hypertension, how to conduct an initial
work-up, how to manage these patients, and when to
refer them to a subspecialist.
Which children should get their blood
pressure checked?
Current recommendations state that all children 3 years of
age and older should have their blood pressure measured
at all health care encounters, including both well child
care and acute care or sick visits. Certain children younger
than 3 with comorbid conditions should also have their BP
measured at each visit. This population includes children
under 3 with1
:
History of prematurity
History of low birth weight or neonatal intensive
care unit (NICU) stay
Presence of congenital heart disease, kidney disease,
or genitourinary abnormality
Family history of congenital kidney disease
Recurrent urinary tract infection (UTI), hematuria,
proteinuria
Transplant of solid organ or bone marrow
Malignancy
Taking medications known to increase blood
pressure (steroids, decongestants, nonsteroidal
anti-inflammatory drugs [NSAIDs], beta-adrenergic
agonists)
Presence of systemic illness associated with hypertension
(neurofibromatosis, tuberous sclerosis)
Evidence of increased intracranial pressure
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Disclosures
Editors Toby Hindin, Jeannette Mallozzi, Jeff Ryan, and
John Merriman disclose that they do not have any financial
relationships with any manufacturer in this area of medicine.
Manuscript reviewers disclose that they do not have any
financial relationships with any manufacturer in this area
of medicine.
DR. BRADY is an assistant professor of pediatric
nephrology at Johns Hopkins University School of
Medicine.
DR. SIBERRY is an assistant professor of pediatrics
in the divisions of general pediatric and adolescent
medicine and pediatric infectious diseases at Johns
Hopkins Hospital.
DR. SOLOMON is an assistant professor of pediatrics
in the division of general pediatrics and adolescent
medicine at Johns Hopkins Hospital, and medical
director of the Harriet Lane Clinic at the Johns
Hopkins School of Medicine.
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HYPERTENSION
ILLUSTRATION:JOEL AND SHARON HARRIS/ARTICULATE GRAPHICS:
