Researcher Urges Early Treatment of Pediatric Hypertension

Norra MacReady

March 16, 2010

March 16, 2010 (Anaheim, California) — Early detection and treatment are critical for managing children with essential hypertension, according to findings presented here at the American Medical Student Association 60th Annual Convention.

Medical student Ajay Lall performed a retrospective analysis of data on everyone referred for the treatment of hypertension to the Pediatric Nephrology and Transplantation Saint Barnabas Medical Center in Livingston, New Jersey, over the past 5 years. The 225 patients ranged in age from 4.5 to 20 years, with a median age of 14 years.

Hypertension secondary to conditions such as renal disease or hyperthyroidism was diagnosed in 78 patients (35%). The remaining 147 (65%) were diagnosed with primary or essential hypertension, meaning no underlying cause could be found.

In all, 118 patients (80%) had a family history of hypertension and 73 (49.6%) were obese, defined as having a body mass index of more than 30 kg/m2. Seventy patients (47.6%) were symptomatic. Common symptoms of pediatric hypertension include headache, difficulty falling asleep, and daytime fatigue.

Many already had evidence of end-organ damage, including 26 patients (23.6% of 110 tested) with left ventricular hypertrophy and 14 (12.2% of 114 tested) with microalbuminuria. Hypertension stage correlated significantly with the presence of symptoms and microalbuminuria, as did being 12 years or older.

Pediatricians who detect hypertension in their patients should refer them to a pediatric nephrologist as soon as possible, because "this might save them from a heart attack when they're 55," said Mr. Lall, a third-year medical student at the Northeastern Ohio Universities College of Medicine in Rootstown.

At least 1 pediatric nephrologist believes pediatricians should check a child's blood pressure more than once before making a referral. "We recommend checking the blood pressure 2 or 3 times, and then referral to a pediatric nephrologist is a good idea so we can look for a cause," said Dorit Ben-Ezer, MD, medical director of the Children's Nephrology Program at the Children's Hospital of Orange County in California.

The patients in this study had an unusually high incidence of essential hypertension, said Dr. Ben-Ezer, who was not involved in the research. She found it interesting that the definition of "childhood" was extended to age 20, and noted that even the median age of 14 was "quite old" for a pediatric population. The incidence of essential hypertension rises in teenagers "because they are closer to being adults, and it is not uncommon in adults," she told Medscape Med Students.

Dr. Ben-Ezer also was skeptical that all of the younger children in this study really did have essential hypertension. "In every kid we see, we are obligated to look for a cause. In a 10-year-old, for example, I move heaven and earth to look for a cause, because there usually is one, and 85% of the time it's in the kidney."

Treatment includes the management of any underlying causes, medication if necessary, and lifestyle changes, such as weight loss, exercise, and a low-salt diet, said Dr. Ben-Ezer.

American Medical Student Association (AMSA) 60th Annual Convention: Abstract 24. Presented March 11, 2010.

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