Severe hypertension in childhood.

The natural history of hypertension in childhood is poorly documented.More data are required, not only as regards aetiology, but also as a guide to prognosis, and for the assessment of effective hypo- tensive agents.We have reviewed those children with a raised blood pressure seen at The Hospital for Sick Children, Great Ormond Street, during the 10-year period 1954-64.The normal values of the blood pressure in children of different ages, and their variations due to cuff size and emotion, are well established (Moss and Adams, 1962; Nadas, 1963).Having full regard for these precautions, only those children with severe hypertension were selected for this series.All patients with a sustained diastolic blood pressure of over 120 mm.Hg were included, if this was accompanied by the presence of cardiomegaly on clinical examination, or left ventri- cular hypertrophy on ECG.Cases of acute nephritis in which the hypertension was a temporary pheno- menon were excluded.An average of 5 patients fulfilling these criteria were seen each year (Fig. 1).The slight increase over the past 5 years may reflect more children being referred for specialized investigations.There was no sex preponderance and the series included 27 girls and 28 boys.