Hypertension in Children

Hypertension in children and adolescents is a major health condition that clinicians frequently overlook. Children should have their blood pressure checked annually beginning at the age of 3, or at each visit if risk factors are present. Secondary etiologies of hypertension are more common in children than adults, with renal parenchymal and renovascular disease being the most common. In youngsters, overweight and obesity are highly associated with primary hypertension. All children newly diagnosed with hypertension should have a history and physical examination to rule out any underlying medical conditions. Other risk factors for cardiovascular disease, such as diabetes mellitus and hyperlipidemia, should be examined in children with hypertension, and a retinal examination and echocardiography should be performed to assess for target organ damage. In children with hypertension, lifestyle adjustments such as weight loss if they are overweight or obese, a nutritious diet, and regular exercise are initially used to address the condition. Children with stage 2 hypertension without a modifiable factor such as obesity, evidence of left ventricular hypertrophy on echocardiography, any stage of hypertension associated with chronic kidney disease, or persistent hypertension despite a trial of lifestyle modifications are more likely to require antihypertensive medications. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide diuretics (thiazide diuretics) are all efficacious, safe, and well tolerated in children.