Hypertension in children and adolescents

The absolute levels of blood pressure (BP) that define hypertension differ in children and adults. Extensive epidemiological data on growth and blood pressure in children and adolescents now provide values for normal ranges of blood pressure throughout childhood. Hypertension in the young is defined as systolic or diastolic blood pressure that is repeatedly above the 95th percentile for age and sex. Regular measurement of blood pressure and use of the reference values now enable accurate detection of hypertension in both symptomatic and asymptomatic children and adolescents. When hypertension is confirmed by repeated blood pressure measurements, decisions must be made regarding further evaluation for diagnosis of a possible underlying cause for the hypertension. In general, the younger the child and the higher the blood pressure, the more likely that a secondary cause, such as a renal parenchymal or renovascular lesion, for the hypertension will be identified. Mild elevations of blood pressure in the young may also be due to early expression of primary or essential hypertension. In children and adolescents, essential hypertension is characterized by blood pressure variability, a family history of hypertension, and, frequently, obesity. Pharmacologic therapy to control significant and severe hypertension is indicated for cardiovascular and renal protection. When early essential hypertension is the likely diagnosis in children or adolescents with mild blood pressure elevation, emphasis is directed at life-style changes including dietary modification, weight control, and increase in physical activity.