Pediatric Hypertension: A Primer for the Busy Primary Care Provider

Hypertension affects up to 5% of all children in the United States. The prevalence of “essential” hypertension in particular is rising in tandem with the childhood obesity epidemic. The primary care provider acts as the first-line of contact for many of these children and has an important role in early detection and referral to subspecialty care when needed. Despite published recommendations from the American Academy of Pediatrics on blood pressure screening at well child visits, adherence to these recommendations remains suboptimal. Elevated blood pressure readings, especially in non-obese children, may be overlooked. This may be due to a variety of factors including unfamiliarity of the primary care provider with pediatric blood pressure norms, time constraints in a busy practice, or the assumption that the elevated reading is an isolated clinically insignificant finding that could be dealt with at a later visit. This is particularly worrisome for children with secondary hypertension, which tends to be more severe and almost always requires anti-hypertensive therapy to prevent end organ damage. In this mini-review we present a case of a late diagnosis of secondary hypertension that had gone unnoticed for years. We then review relevant literature and suggest a clinical approach to the hypertensive child in a concise format useful for the busy primary care provider. A consistent clinical approach and firm understanding of the basic principles of pediatric hypertension diagnosis and management can prevent untoward outcomes related to a missed diagnosis.