Pediatric Hypertension: Current Strategies and Clinical Management

Hypertension is a common disease. Prevalence of hypertension appears to be increasing in school-aged children. Many hypertensive children are unaware of such condition. Morbidity and mortality of hypertension cannot be ignored. Proper diagnosis and treatment is essential to overcome hypertension related complications. Treatment depends on type and stage of hypertension, associated co-morbid condition, underlying etiology and on some other factors. Initial management of essential hypertension generally comprises life style modifications and most children with sustained secondary hypertension require anti-hypertensive agents. The objective of treatment of hypertension without hypertensive target-organ damage is to maintain BP <95th percentile for the child. Commonly used medications in children include angiotensin converting enzyme inhibitors, calcium channel blockers, vasodilators, β blockers and thiazide diuretics. Therapy is started generally with one agent and the highest recommended dose is achieved. A drug from a different class is added or substituted if the highest dose is ineffective. More frequent adjustment of medications is to be avoided. Blood pressure is monitored properly. Some patients require life-long therapy whereas others may require a gradual reduction of drug after satisfactory control of BP over a period. Therapy may be discontinued carefully if the underlying cause is corrected. Surgical intervention may be needed in certain cases in children. J Bangladesh Coll Phys Surg 2026; 44: 189-197