How is hypertension managed in children with chronic kidney disease (CKD)?

Updated: Jul 21, 2020
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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Hypertension is a highly significant and independent predictor for progression of chronic kidney disease (CKD) in children. [24] It has been reported that at least 38% of children with chronic kidney disease in the United States receive antihypertensive therapy. [25]  Hypertension has also been found to be a predictor of mortality in children with CKD. [26]

The optimal target blood pressure for children with chronic renal failure is recommended to be below the 90th percentile for age. Treatment of even mild hypertension is important in patients with chronic renal failure to protect against both progressive renal failure and cardiovascular disease, which is markedly increased in even moderate chronic renal disease.

Treatment of hypertension in children, with and without chronic kidney disease, is based on 3 factors: (1) degree of blood pressure elevation, (2) the presence of cardiovascular risk factors, and (3) the presence of end-organ damage. Additionally, the initial antihypertensive agent may be selected based on cause of chronic kidney disease and age.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have an additional benefit in at least some patients with chronic renal disease, slowing the rate of progressive renal injury, independent of the activity of the underlying disease.

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